Provider First Line Business Practice Location Address:
511 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:
859-239-2379
Provider Business Practice Location Address Fax Number:
859-239-6898
Provider Enumeration Date:
10/25/2006