Provider First Line Business Practice Location Address:
110 S LOCUST 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:
40311-1123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-289-5418
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/01/2023