Provider First Line Business Practice Location Address:
1140 BARNES MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-8730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-623-3780
Provider Business Practice Location Address Fax Number:
859-623-8377
Provider Enumeration Date:
02/16/2010