Provider First Line Business Practice Location Address:
613 23RD ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2878
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-326-9847
Provider Business Practice Location Address Fax Number:
606-324-3418
Provider Enumeration Date:
10/25/2006