Provider First Line Business Practice Location Address:
1216 B NORTH RACE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLASGOW
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-651-9408
Provider Business Practice Location Address Fax Number:
270-651-6023
Provider Enumeration Date:
01/11/2007