Provider First Line Business Practice Location Address:
1800 HIGHLAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008-8770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-316-6675
Provider Business Practice Location Address Fax Number:
502-371-6110
Provider Enumeration Date:
04/30/2024