Provider First Line Business Practice Location Address:
639 NORTH MULBERRY STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-1931
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-737-4600
Provider Business Practice Location Address Fax Number:
270-737-1722
Provider Enumeration Date:
01/21/2011