Provider First Line Business Practice Location Address:
106 W CLAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42031-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-653-6277
Provider Business Practice Location Address Fax Number:
270-653-4097
Provider Enumeration Date:
03/09/2006