Provider First Line Business Practice Location Address:
581 DUDLEY RD.
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:
41017-3296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-0888
Provider Business Practice Location Address Fax Number:
859-341-3386
Provider Enumeration Date:
03/11/2008