Provider First Line Business Practice Location Address:
155 W SEMINARY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-1573
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-3292
Provider Business Practice Location Address Fax Number:
859-578-2864
Provider Enumeration Date:
04/18/2014