Provider First Line Business Practice Location Address:
126 ARMORY HILL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40069-1204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-336-5435
Provider Business Practice Location Address Fax Number:
859-336-5407
Provider Enumeration Date:
07/22/2005