Provider First Line Business Practice Location Address:
700 SULPHUR WELLS ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-475-4750
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/09/2025