Provider First Line Business Practice Location Address:
401 S JEFFERSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRINCETON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42445-2113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-365-7588
Provider Business Practice Location Address Fax Number:
270-365-7586
Provider Enumeration Date:
01/13/2006