Provider First Line Business Practice Location Address:
205 MARWILL DR
Provider Second Line Business Practice Location Address:
RIVERBOURNE MEDICAL PLAZA
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-732-0695
Provider Business Practice Location Address Fax Number:
502-561-8032
Provider Enumeration Date:
07/08/2007