Provider First Line Business Practice Location Address:
401 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-598-6791
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2022