Provider First Line Business Practice Location Address:
143 WOODFORD STREET
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-8644
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/18/2012