Provider First Line Business Practice Location Address:
201 W 8TH ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-987-0077
Provider Business Practice Location Address Fax Number:
859-987-2279
Provider Enumeration Date:
10/03/2012