Provider First Line Business Practice Location Address:
1230 MARKET ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-7986
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-225-6900
Provider Business Practice Location Address Fax Number:
502-666-7693
Provider Enumeration Date:
04/18/2006