Provider First Line Business Practice Location Address:
517 LEGION DR
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:
859-734-7709
Provider Business Practice Location Address Fax Number:
959-734-7700
Provider Enumeration Date:
10/23/2006