Provider First Line Business Practice Location Address:
5900 N DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-8881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-737-1215
Provider Business Practice Location Address Fax Number:
270-737-1220
Provider Enumeration Date:
05/21/2009