Provider First Line Business Practice Location Address:
928 W JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEREA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40403-1480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-985-8585
Provider Business Practice Location Address Fax Number:
859-985-8781
Provider Enumeration Date:
07/12/2005