Provider First Line Business Practice Location Address:
313 W MADISON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-741-2695
Provider Business Practice Location Address Fax Number:
502-225-9901
Provider Enumeration Date:
01/03/2007