Provider First Line Business Practice Location Address:
1112 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-598-9595
Provider Business Practice Location Address Fax Number:
270-598-9590
Provider Enumeration Date:
01/26/2006