Provider First Line Business Practice Location Address:
99 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRY RIDGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41035-7343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-785-5717
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2021