Provider First Line Business Practice Location Address:
322 S JEFFERSON ST
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:
41230-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
506-638-3234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/08/2010