Provider First Line Business Practice Location Address:
108 W MADISON STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-638-4900
Provider Business Practice Location Address Fax Number:
606-638-4950
Provider Enumeration Date:
10/06/2006