Provider First Line Business Practice Location Address:
1750 HIGHWAY 192 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONDON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40741-2639
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-276-1511
Provider Business Practice Location Address Fax Number:
859-276-3373
Provider Enumeration Date:
03/13/2008