Provider First Line Business Practice Location Address:
214 N JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-1110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-1029
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2018