Provider First Line Business Practice Location Address:
20 NORTH GRAND AVE.
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
FT. THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-1755
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-891-0650
Provider Business Practice Location Address Fax Number:
513-891-2838
Provider Enumeration Date:
05/23/2012