Provider First Line Business Practice Location Address:
11 MANCHESTER SQUARE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-598-8922
Provider Business Practice Location Address Fax Number:
606-598-6244
Provider Enumeration Date:
12/21/2006