Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3970
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-8074
Provider Business Practice Location Address Fax Number:
859-301-4945
Provider Enumeration Date:
08/01/2021