Provider First Line Business Practice Location Address:
1134 US HWY 27 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYNTHIANA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41031-7570
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-234-5600
Provider Business Practice Location Address Fax Number:
859-234-5606
Provider Enumeration Date:
10/27/2010