Provider First Line Business Practice Location Address:
327 E WOODFORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-1145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-604-1290
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/22/2007