Provider First Line Business Practice Location Address:
1210 KY HWY 36 EAST
Provider Second Line Business Practice Location Address:
SUITE G4
Provider Business Practice Location Address City Name:
CYNTHIANA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-234-9955
Provider Business Practice Location Address Fax Number:
859-234-9959
Provider Enumeration Date:
01/26/2007