Provider First Line Business Practice Location Address:
341 E MAIN 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:
40361-2116
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-879-1915
Provider Business Practice Location Address Fax Number:
859-987-3230
Provider Enumeration Date:
11/08/2006