Provider First Line Business Practice Location Address:
610 ELIZAVILLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLEMINGSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41041-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-849-2212
Provider Business Practice Location Address Fax Number:
606-849-2242
Provider Enumeration Date:
01/24/2007