Provider First Line Business Practice Location Address:
KENTUCKY STATE REFORMATORY
Provider Second Line Business Practice Location Address:
3001 W. HIGHWAY 146
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40032-0002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-9441
Provider Business Practice Location Address Fax Number:
502-225-0693
Provider Enumeration Date:
02/22/2007