Provider First Line Business Practice Location Address:
160 E, MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT VERNON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40456-0609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-256-2961
Provider Business Practice Location Address Fax Number:
606-256-3562
Provider Enumeration Date:
10/23/2006