Provider First Line Business Practice Location Address:
3005 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-344-8000
Provider Business Practice Location Address Fax Number:
859-344-8001
Provider Enumeration Date:
07/10/2006