Provider First Line Business Practice Location Address:
102 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EARLINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42410-1334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-383-3784
Provider Business Practice Location Address Fax Number:
270-383-3297
Provider Enumeration Date:
10/19/2006