Provider First Line Business Practice Location Address:
1320 WOODLAND DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-769-1100
Provider Business Practice Location Address Fax Number:
270-737-8688
Provider Enumeration Date:
07/20/2005