Provider First Line Business Practice Location Address:
120 N WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-1354
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-559-7576
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2010