Provider First Line Business Practice Location Address:
113 E 2ND ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-5792
Provider Business Practice Location Address Fax Number:
270-756-5729
Provider Enumeration Date:
09/06/2005