Provider First Line Business Practice Location Address:
432 - 16TH STREET
Provider Second Line Business Practice Location Address:
SUITE B- TRI STATE NEPHROLOGY
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-9335
Provider Business Practice Location Address Fax Number:
606-324-6383
Provider Enumeration Date:
12/31/2009