Provider First Line Business Practice Location Address:
1020 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-2370
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-586-8947
Provider Business Practice Location Address Fax Number:
270-813-1173
Provider Enumeration Date:
09/21/2022