Provider First Line Business Practice Location Address:
104 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-542-7381
Provider Business Practice Location Address Fax Number:
270-542-7381
Provider Enumeration Date:
01/26/2007