Provider First Line Business Practice Location Address:
120 HELMWOOD PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-5631
Provider Business Practice Location Address Fax Number:
270-737-6229
Provider Enumeration Date:
05/11/2007