Provider First Line Business Practice Location Address:
201 MILLERSTOWN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42726-0146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-242-3811
Provider Business Practice Location Address Fax Number:
270-242-4171
Provider Enumeration Date:
09/28/2006