Provider First Line Business Practice Location Address:
2835 S HIGHWAY 393
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-530-4808
Provider Business Practice Location Address Fax Number:
502-530-5828
Provider Enumeration Date:
07/12/2023