Provider First Line Business Practice Location Address:
1609 N DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-6473
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-7372
Provider Business Practice Location Address Fax Number:
270-737-3936
Provider Enumeration Date:
10/23/2006