Provider First Line Business Practice Location Address:
1606 N DIXIE HWY STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-5572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-234-8880
Provider Business Practice Location Address Fax Number:
270-234-1343
Provider Enumeration Date:
01/29/2008