Provider First Line Business Practice Location Address:
2647 N US HWY 25
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729-0548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-843-6060
Provider Business Practice Location Address Fax Number:
606-843-7243
Provider Enumeration Date:
11/20/2007