Provider First Line Business Practice Location Address:
19 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035-7332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-823-0111
Provider Business Practice Location Address Fax Number:
859-823-9111
Provider Enumeration Date:
07/12/2021