Provider First Line Business Practice Location Address:
419 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-340-9119
Provider Business Practice Location Address Fax Number:
859-972-0899
Provider Enumeration Date:
07/13/2014