Provider First Line Business Practice Location Address:
117 E JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-224-2273
Provider Business Practice Location Address Fax Number:
859-224-4675
Provider Enumeration Date:
09/16/2021