Provider First Line Business Practice Location Address:
214 S CHILES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
185-973-4278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2012