Provider First Line Business Practice Location Address:
470 LINDEN AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330-1871
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-734-4307
Provider Business Practice Location Address Fax Number:
859-734-4300
Provider Enumeration Date:
10/15/2007