Provider First Line Business Practice Location Address:
133 BARNWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-426-1616
Provider Business Practice Location Address Fax Number:
859-578-3321
Provider Enumeration Date:
01/08/2007