Provider First Line Business Practice Location Address:
8140 U.S. RT 60
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:
41102-9522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-329-1344
Provider Business Practice Location Address Fax Number:
606-928-4342
Provider Enumeration Date:
10/20/2010