Provider First Line Business Practice Location Address:
203 FAIRGROUNDS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARDINSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-756-2171
Provider Business Practice Location Address Fax Number:
270-756-2855
Provider Enumeration Date:
02/24/2006