Provider First Line Business Practice Location Address:
2003 OLD MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-759-9800
Provider Business Practice Location Address Fax Number:
606-759-9710
Provider Enumeration Date:
02/20/2007