Provider First Line Business Practice Location Address:
403 N COLLEGE 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:
42134-1829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-586-5181
Provider Business Practice Location Address Fax Number:
270-586-7933
Provider Enumeration Date:
07/21/2005