Provider First Line Business Practice Location Address:
122 W THIRD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-7950
Provider Business Practice Location Address Fax Number:
270-756-7949
Provider Enumeration Date:
07/21/2006