Provider First Line Business Practice Location Address:
436 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-987-5550
Provider Business Practice Location Address Fax Number:
859-987-2465
Provider Enumeration Date:
06/29/2011