Provider First Line Business Practice Location Address:
115 WATER ST
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
HORSE CAVE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42749-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-786-4546
Provider Business Practice Location Address Fax Number:
270-786-4037
Provider Enumeration Date:
03/19/2008