Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DRIVE SUITE 354
Provider Second Line Business Practice Location Address:
ATTN. BEVERLY MEYER
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-4665
Provider Business Practice Location Address Fax Number:
859-331-6370
Provider Enumeration Date:
05/30/2006