Provider First Line Business Practice Location Address:
101 FAIRGROUNDS RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-2159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007