Provider First Line Business Practice Location Address:
5301 W HWY 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014-8596
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-243-2400
Provider Business Practice Location Address Fax Number:
502-243-1281
Provider Enumeration Date:
04/26/2007