Provider First Line Business Practice Location Address:
402 SCHOOL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729-6251
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-682-1360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2014