Provider First Line Business Practice Location Address:
1704 TOWNE MALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-6686
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-3551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006