Provider First Line Business Practice Location Address:
83 WHITE OAK SCHOOL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42539-6180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-481-1375
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2019