Provider First Line Business Practice Location Address:
118 S MAIN ST
Provider Second Line Business Practice Location Address:
SUITES 6 & 7
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-7007
Provider Business Practice Location Address Fax Number:
859-824-7077
Provider Enumeration Date:
07/08/2006