Provider First Line Business Practice Location Address:
9207 US HIGHWAY 42 STE F
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-9391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-228-4700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/09/2024