Provider First Line Business Practice Location Address:
67 PUBLIC SQ
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40444-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-792-1420
Provider Business Practice Location Address Fax Number:
859-792-1240
Provider Enumeration Date:
03/19/2015