Provider First Line Business Practice Location Address:
1105 MARY T MEAGHER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-7990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-737-1733
Provider Business Practice Location Address Fax Number:
270-737-2949
Provider Enumeration Date:
08/30/2006