Provider First Line Business Practice Location Address:
7455 HOWARDSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW HAVEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40051-6505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-735-2185
Provider Business Practice Location Address Fax Number:
270-769-0183
Provider Enumeration Date:
06/23/2008