Provider First Line Business Practice Location Address:
147 W 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:
40342-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-0121
Provider Business Practice Location Address Fax Number:
502-839-1607
Provider Enumeration Date:
10/30/2015