Provider First Line Business Practice Location Address:
15 SO MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW CASTLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40050
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-845-7550
Provider Business Practice Location Address Fax Number:
502-845-5551
Provider Enumeration Date:
09/25/2006