Provider First Line Business Practice Location Address:
560 SOUTH LOOP ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-5600
Provider Business Practice Location Address Fax Number:
859-301-5669
Provider Enumeration Date:
10/24/2005