Provider First Line Business Practice Location Address:
236 E WOODFORD 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:
40342-1144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-859-9075
Provider Business Practice Location Address Fax Number:
502-859-9076
Provider Enumeration Date:
09/20/2006