Provider First Line Business Practice Location Address:
5270 ELMBURG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAGDAD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40003-8000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-265-6243
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2023