Provider First Line Business Practice Location Address:
107 W WOODFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-1153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-3111
Provider Business Practice Location Address Fax Number:
502-839-4133
Provider Enumeration Date:
11/10/2006