Provider First Line Business Practice Location Address:
10178 HIGHWAY 27 NORTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUTLER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-472-3395
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2007