Provider First Line Business Practice Location Address:
227 ELM ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUDLOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41016-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-814-8255
Provider Business Practice Location Address Fax Number:
859-815-8528
Provider Enumeration Date:
07/15/2010