Provider First Line Business Practice Location Address:
2000 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-370-1187
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2018