Provider First Line Business Practice Location Address:
560 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:
41017-3405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-0622
Provider Business Practice Location Address Fax Number:
513-889-1850
Provider Enumeration Date:
01/25/2006