Provider First Line Business Practice Location Address:
1606 N DIXIE HWY
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-5565
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:
10/05/2006