Provider First Line Business Practice Location Address:
20 E 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-987-3272
Provider Business Practice Location Address Fax Number:
859-987-3273
Provider Enumeration Date:
09/28/2015