Provider First Line Business Practice Location Address:
218 W FRENCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-300-4411
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/13/2007