Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DR.
Provider Second Line Business Practice Location Address:
SUITE 107
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:
859-344-8333
Provider Business Practice Location Address Fax Number:
859-344-0052
Provider Enumeration Date:
01/14/2006