Provider First Line Business Practice Location Address:
PARKLANE SHOPPING CENTER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-732-4331
Provider Business Practice Location Address Fax Number:
502-732-9182
Provider Enumeration Date:
01/11/2007