Provider First Line Business Practice Location Address:
2100 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRVIEW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-324-3877
Provider Business Practice Location Address Fax Number:
606-327-2288
Provider Enumeration Date:
09/15/2009