Provider First Line Business Practice Location Address:
10731 HIGHWAY 44 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-7696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-0500
Provider Business Practice Location Address Fax Number:
502-589-1556
Provider Enumeration Date:
02/14/2007