Provider First Line Business Practice Location Address:
661 ASHLEY CAMP RD
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:
40330-8711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-905-8699
Provider Business Practice Location Address Fax Number:
859-554-4086
Provider Enumeration Date:
03/05/2007