Provider First Line Business Practice Location Address:
103 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-1013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-3406
Provider Business Practice Location Address Fax Number:
502-839-2501
Provider Enumeration Date:
01/05/2007