Provider First Line Business Practice Location Address:
PO BOX 104; 1028 NORTH 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:
40330-0104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-734-5437
Provider Business Practice Location Address Fax Number:
859-715-0818
Provider Enumeration Date:
12/27/2006