Provider First Line Business Practice Location Address:
10650 US ROUTE 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:
41102-9611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-327-7337
Provider Business Practice Location Address Fax Number:
606-326-7798
Provider Enumeration Date:
11/28/2006