Provider First Line Business Practice Location Address:
1028 N COLLEGE ST STE 8B
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:
40330-2227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-605-2214
Provider Business Practice Location Address Fax Number:
859-402-2606
Provider Enumeration Date:
03/22/2023