Provider First Line Business Practice Location Address:
501 W POPLAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-6156
Provider Business Practice Location Address Fax Number:
270-765-6157
Provider Enumeration Date:
08/10/2006