Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
STE 258
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-2666
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
12/13/2005