Provider First Line Business Practice Location Address:
95 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035-7343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-9898
Provider Business Practice Location Address Fax Number:
859-282-9852
Provider Enumeration Date:
04/17/2007