Provider First Line Business Practice Location Address:
4000 N US HWY 119
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAXTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-573-3006
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/16/2008