Provider First Line Business Practice Location Address:
308 S WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-1340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-254-3021
Provider Business Practice Location Address Fax Number:
270-254-3023
Provider Enumeration Date:
03/16/2006