Provider First Line Business Practice Location Address:
549 MIDDLEBURG ST.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-787-1950
Provider Business Practice Location Address Fax Number:
606-787-0123
Provider Enumeration Date:
10/21/2009