Provider First Line Business Practice Location Address:
998 DUDLEY PIKE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-426-1100
Provider Business Practice Location Address Fax Number:
859-426-0809
Provider Enumeration Date:
10/31/2006