Provider First Line Business Practice Location Address:
400 E COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-237-2950
Provider Business Practice Location Address Fax Number:
229-237-2950
Provider Enumeration Date:
05/16/2017