Provider First Line Business Practice Location Address:
160 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT. VERNON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-256-2961
Provider Business Practice Location Address Fax Number:
606-256-3562
Provider Enumeration Date:
03/27/2012