Provider First Line Business Practice Location Address:
1629 ASHLAND RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENUP
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41144-1249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-473-0687
Provider Business Practice Location Address Fax Number:
606-473-0689
Provider Enumeration Date:
05/12/2010