Provider First Line Business Practice Location Address:
500 BALLPARK RD
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:
40143-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-6202
Provider Business Practice Location Address Fax Number:
270-756-1906
Provider Enumeration Date:
05/04/2006