Provider First Line Business Practice Location Address:
105 SOUTH HAMILTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-6383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-868-0930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/13/2010