Provider First Line Business Practice Location Address:
876 S COLLEGE 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:
40330-2140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-605-6123
Provider Business Practice Location Address Fax Number:
859-605-6127
Provider Enumeration Date:
08/12/2013