Provider First Line Business Practice Location Address:
1500 BLQZER BOULEVARD
Provider Second Line Business Practice Location Address:
PAUL G. BLAZER SENIOR HIGH SCHOOL
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-327-6050
Provider Business Practice Location Address Fax Number:
606-324-0517
Provider Enumeration Date:
07/18/2006