Provider First Line Business Practice Location Address:
1203 13TH ST REAR
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:
606-329-2644
Provider Business Practice Location Address Fax Number:
513-297-0746
Provider Enumeration Date:
10/27/2014