Provider First Line Business Practice Location Address:
11436 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41091-9483
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-384-2927
Provider Business Practice Location Address Fax Number:
859-384-2927
Provider Enumeration Date:
09/03/2008