Provider First Line Business Practice Location Address:
2380 GRANDVIEW DR
Provider Second Line Business Practice Location Address:
ST ELIZABETH PHYSICIANS
Provider Business Practice Location Address City Name:
FT MITCHELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-7234
Provider Business Practice Location Address Fax Number:
859-578-7986
Provider Enumeration Date:
05/03/2006