Provider First Line Business Practice Location Address:
549 LAFAYETTE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELLEVUE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41073-1333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-431-4430
Provider Business Practice Location Address Fax Number:
859-431-9560
Provider Enumeration Date:
02/02/2006