Provider First Line Business Practice Location Address:
6165 W. HIGHWAY 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BUCKNER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-8880
Provider Business Practice Location Address Fax Number:
502-222-8885
Provider Enumeration Date:
01/14/2010