Provider First Line Business Practice Location Address:
224 FRANKFORT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-735-3114
Provider Business Practice Location Address Fax Number:
606-735-3114
Provider Enumeration Date:
10/23/2006