Provider First Line Business Practice Location Address:
10424 HIGHWAY 44 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-6319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-251-9191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2025