Provider First Line Business Practice Location Address:
2204 COURTNEY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-0243
Provider Business Practice Location Address Fax Number:
502-225-4907
Provider Enumeration Date:
02/26/2007