Provider First Line Business Practice Location Address:
EASTERSEALS CARDINAL HILL
Provider Second Line Business Practice Location Address:
993 MANSON HEADLEY ROAD
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-2246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-367-7217
Provider Business Practice Location Address Fax Number:
859-367-7155
Provider Enumeration Date:
11/25/2019