Provider First Line Business Practice Location Address:
2201 LEXINGTON AVE
Provider Second Line Business Practice Location Address:
C/O TARA LANDERS
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-2843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-408-4000
Provider Business Practice Location Address Fax Number:
304-429-3109
Provider Enumeration Date:
03/19/2015