Provider First Line Business Practice Location Address:
100 S. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-613-8178
Provider Business Practice Location Address Fax Number:
859-908-2501
Provider Enumeration Date:
07/16/2006