Provider First Line Business Practice Location Address:
236 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-1628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-623-2844
Provider Business Practice Location Address Fax Number:
859-623-2110
Provider Enumeration Date:
02/21/2008