Provider First Line Business Practice Location Address:
308 SOUTH WASHINGTON STREET SUITE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-653-0220
Provider Business Practice Location Address Fax Number:
270-653-0221
Provider Enumeration Date:
09/04/2017