Provider First Line Business Practice Location Address:
2120 CARTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-8158
Provider Business Practice Location Address Fax Number:
606-329-1164
Provider Enumeration Date:
04/21/2006