Provider First Line Business Practice Location Address:
649 CHAMBERLIN AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-214-1686
Provider Business Practice Location Address Fax Number:
502-875-1686
Provider Enumeration Date:
03/05/2007