Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DR
Provider Second Line Business Practice Location Address:
20 MEDICAL VILLAGE DRIVE SUITE 258
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7246
Provider Business Practice Location Address Fax Number:
859-341-7867
Provider Enumeration Date:
07/25/2006