Provider First Line Business Practice Location Address:
408 S 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-1399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-0322
Provider Business Practice Location Address Fax Number:
502-222-2244
Provider Enumeration Date:
04/26/2011