Provider First Line Business Practice Location Address:
9517 US HIGHWAY 42 STE 410
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-9237
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-587-0521
Provider Business Practice Location Address Fax Number:
502-587-3893
Provider Enumeration Date:
07/21/2006