Provider First Line Business Practice Location Address:
24 CLINIC DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-987-0400
Provider Business Practice Location Address Fax Number:
859-987-0409
Provider Enumeration Date:
07/23/2006