Provider First Line Business Practice Location Address:
289 IRELAND AVE
Provider Second Line Business Practice Location Address:
BLDG 851 VA CLINIC
Provider Business Practice Location Address City Name:
FORT KNOX
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40121-5111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-624-0235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2005