Provider First Line Business Practice Location Address:
336 29TH ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-1900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-0051
Provider Business Practice Location Address Fax Number:
606-325-2244
Provider Enumeration Date:
07/08/2006