Provider First Line Business Practice Location Address:
500 W BROADWAY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-1306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-5113
Provider Business Practice Location Address Fax Number:
502-839-9831
Provider Enumeration Date:
02/28/2008