Provider First Line Business Practice Location Address:
1203 13TH ST
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:
41101-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-7149
Provider Business Practice Location Address Fax Number:
606-325-1929
Provider Enumeration Date:
04/13/2011