Provider First Line Business Practice Location Address:
100 BAUGHMAN AVE.
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-238-9300
Provider Business Practice Location Address Fax Number:
859-238-9977
Provider Enumeration Date:
01/29/2008