Provider First Line Business Practice Location Address:
323 CENTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40051-6319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-350-5191
Provider Business Practice Location Address Fax Number:
502-349-6599
Provider Enumeration Date:
10/19/2012