Provider First Line Business Practice Location Address:
425 JAMES HANNAH DRIVE
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SOUTH SHORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-932-4546
Provider Business Practice Location Address Fax Number:
606-932-3885
Provider Enumeration Date:
02/14/2012