Provider First Line Business Practice Location Address:
40 NORTH GRAND AVE.
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
FT. THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-781-4900
Provider Business Practice Location Address Fax Number:
859-781-3039
Provider Enumeration Date:
10/26/2005