Provider First Line Business Practice Location Address:
111 HUMES RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41097-9444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-823-1811
Provider Business Practice Location Address Fax Number:
859-823-1855
Provider Enumeration Date:
04/23/2008