Provider First Line Business Practice Location Address:
483 S LOOP 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:
41017-5446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-4600
Provider Business Practice Location Address Fax Number:
859-301-4601
Provider Enumeration Date:
07/19/2005