Provider First Line Business Practice Location Address:
584 N COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-734-9992
Provider Business Practice Location Address Fax Number:
859-734-9929
Provider Enumeration Date:
05/21/2007