Provider First Line Business Practice Location Address:
352 S COLLEGE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARRODSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40330-1875
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-613-8178
Provider Business Practice Location Address Fax Number:
859-865-1370
Provider Enumeration Date:
07/31/2006