Provider First Line Business Practice Location Address:
310 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40033-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-692-1871
Provider Business Practice Location Address Fax Number:
270-692-6785
Provider Enumeration Date:
01/25/2006