Provider First Line Business Practice Location Address:
137 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40069-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-336-0771
Provider Business Practice Location Address Fax Number:
859-336-0772
Provider Enumeration Date:
08/31/2009