Provider First Line Business Practice Location Address:
1112 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42134-2322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-482-0101
Provider Business Practice Location Address Fax Number:
270-850-3120
Provider Enumeration Date:
07/21/2011