Provider First Line Business Practice Location Address:
112 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-1357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-498-5784
Provider Business Practice Location Address Fax Number:
859-498-4701
Provider Enumeration Date:
08/15/2005