Provider First Line Business Practice Location Address:
448 SOUTH 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-236-2053
Provider Business Practice Location Address Fax Number:
859-236-2863
Provider Enumeration Date:
12/01/2005