Provider First Line Business Practice Location Address:
1131 S COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-2309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-586-8261
Provider Business Practice Location Address Fax Number:
270-586-8264
Provider Enumeration Date:
11/01/2007