Provider First Line Business Practice Location Address:
470 HIGHWAY 421
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40006-0247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-255-7732
Provider Business Practice Location Address Fax Number:
502-255-3970
Provider Enumeration Date:
11/20/2006