Provider First Line Business Practice Location Address:
203 S WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-1387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-4504
Provider Business Practice Location Address Fax Number:
606-638-4186
Provider Enumeration Date:
10/11/2005