Provider First Line Business Practice Location Address:
312 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42347-1129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-298-3279
Provider Business Practice Location Address Fax Number:
270-298-7641
Provider Enumeration Date:
07/13/2006