Provider First Line Business Practice Location Address:
212 ELIZABETH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-1815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-317-5544
Provider Business Practice Location Address Fax Number:
270-234-9043
Provider Enumeration Date:
05/08/2007