Provider First Line Business Practice Location Address:
1200 BATH AVE
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-2491
Provider Business Practice Location Address Fax Number:
606-324-7676
Provider Enumeration Date:
01/26/2006