Provider First Line Business Practice Location Address:
11099 HIGHWAY 44 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-6243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-4291
Provider Business Practice Location Address Fax Number:
502-538-4591
Provider Enumeration Date:
09/22/2011