Provider First Line Business Practice Location Address:
145 SALINGER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-2084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-312-0290
Provider Business Practice Location Address Fax Number:
502-214-5958
Provider Enumeration Date:
10/04/2007