Provider First Line Business Practice Location Address:
2659 NORTH LAUREL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729-0495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-843-6195
Provider Business Practice Location Address Fax Number:
606-843-6195
Provider Enumeration Date:
06/07/2017