Provider First Line Business Practice Location Address:
143 W WOODFORD 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:
40342-1580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-320-8551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/10/2020