Provider First Line Business Practice Location Address:
106 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-484-2319
Provider Business Practice Location Address Fax Number:
502-484-0841
Provider Enumeration Date:
07/30/2007