Provider First Line Business Practice Location Address:
318 N MAIN ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-1430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-462-0094
Provider Business Practice Location Address Fax Number:
502-462-1148
Provider Enumeration Date:
03/01/2016