Provider First Line Business Practice Location Address: 
639 NORTH MULBERRY STREET
    Provider Second Line Business Practice Location Address: 
HEARTLAND ANESTHESIA CONSULTANTS, P.S.C.
    Provider Business Practice Location Address City Name: 
ELIZABETHTOWN
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
42701-1931
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
270-737-4600
    Provider Business Practice Location Address Fax Number: 
270-737-1722
    Provider Enumeration Date: 
07/15/2011