Provider First Line Business Practice Location Address:
2725 US HWY 25 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-843-6476
Provider Business Practice Location Address Fax Number:
606-843-6176
Provider Enumeration Date:
09/06/2006