Provider First Line Business Practice Location Address:
323 C SOUTH JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-365-2494
Provider Business Practice Location Address Fax Number:
270-365-2496
Provider Enumeration Date:
12/26/2007