Provider First Line Business Practice Location Address:
1815 N DIXIE HWY STE 4
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:
42701-9424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-360-0077
Provider Business Practice Location Address Fax Number:
270-360-9067
Provider Enumeration Date:
03/27/2007