Provider First Line Business Practice Location Address:
610 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-363-2035
Provider Business Practice Location Address Fax Number:
859-578-3689
Provider Enumeration Date:
11/13/2006