Provider First Line Business Practice Location Address:
107 S BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARLISLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40311-1150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-289-4124
Provider Business Practice Location Address Fax Number:
859-289-4126
Provider Enumeration Date:
12/29/2009