Provider First Line Business Practice Location Address:
118 S MAIN ST STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035-9436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-824-5454
Provider Business Practice Location Address Fax Number:
859-824-9182
Provider Enumeration Date:
06/14/2011