Provider First Line Business Practice Location Address:
705 S COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330-2105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-605-2170
Provider Business Practice Location Address Fax Number:
859-605-2146
Provider Enumeration Date:
02/14/2024