Provider First Line Business Practice Location Address:
HWY 644
Provider Second Line Business Practice Location Address:
TRM PLAZA
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:
606-638-1154
Provider Business Practice Location Address Fax Number:
606-638-4502
Provider Enumeration Date:
09/14/2006