Provider First Line Business Practice Location Address:
226 SOUTH BELL AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42740-0153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-369-8495
Provider Business Practice Location Address Fax Number:
270-369-0099
Provider Enumeration Date:
03/08/2007