Provider First Line Business Practice Location Address:
410 E MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-0222
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/16/2007