Provider First Line Business Practice Location Address:
5850 US ROUTE 60
Provider Second Line Business Practice Location Address:
SUITE O
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102-9516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-928-4900
Provider Business Practice Location Address Fax Number:
606-928-4923
Provider Enumeration Date:
02/10/2007