Provider First Line Business Practice Location Address:
1215 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MONTICELLO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42633-2900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-340-8825
Provider Business Practice Location Address Fax Number:
606-340-0097
Provider Enumeration Date:
10/18/2007