Provider First Line Business Practice Location Address:
108 NEW GLENDALE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-1023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-769-1601
Provider Business Practice Location Address Fax Number:
270-765-7274
Provider Enumeration Date:
12/11/2014