Provider First Line Business Practice Location Address:
3037 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2340
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-578-0022
Provider Business Practice Location Address Fax Number:
859-441-6380
Provider Enumeration Date:
12/18/2007