Provider First Line Business Practice Location Address:
400 N WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40069-1428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-481-2672
Provider Business Practice Location Address Fax Number:
859-554-2725
Provider Enumeration Date:
03/17/2007