Provider First Line Business Practice Location Address:
249 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST LIBERTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41472-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-743-4493
Provider Business Practice Location Address Fax Number:
606-743-8350
Provider Enumeration Date:
05/03/2007