Provider First Line Business Practice Location Address:
520 NORTH MILES STREET
Provider Second Line Business Practice Location Address:
SUITE D INMAN ORTHODONTICS
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-1874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-769-1349
Provider Business Practice Location Address Fax Number:
270-769-4605
Provider Enumeration Date:
12/27/2006