Provider First Line Business Practice Location Address:
129 SOUTH WINTER STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDWAY
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-846-4445
Provider Business Practice Location Address Fax Number:
859-846-4761
Provider Enumeration Date:
07/20/2007