Provider First Line Business Practice Location Address:
675 EAST HWY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143-0675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-2151
Provider Business Practice Location Address Fax Number:
270-756-5199
Provider Enumeration Date:
05/23/2005