Provider First Line Business Practice Location Address: 
470 LINDEN AVE STE 7
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
HARRODSBURG
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40330
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-733-5859
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
02/25/2013