Provider First Line Business Practice Location Address:
1214 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41097-8502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-823-0200
Provider Business Practice Location Address Fax Number:
859-823-4500
Provider Enumeration Date:
03/31/2007