Provider First Line Business Practice Location Address:
125 E M L KING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40033-1550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-699-9949
Provider Business Practice Location Address Fax Number:
270-699-2424
Provider Enumeration Date:
04/12/2007