Provider First Line Business Practice Location Address:
124 LIBERTY SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42539-3392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-787-5061
Provider Business Practice Location Address Fax Number:
606-787-5063
Provider Enumeration Date:
06/02/2006