Provider First Line Business Practice Location Address:
1118 S FT THOMAS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-781-3090
Provider Business Practice Location Address Fax Number:
859-781-3135
Provider Enumeration Date:
06/13/2007