Provider First Line Business Practice Location Address:
312 W HIGH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-692-9559
Provider Business Practice Location Address Fax Number:
270-692-9236
Provider Enumeration Date:
02/09/2009