Provider First Line Business Practice Location Address:
9611 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41091-8810
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-384-3342
Provider Business Practice Location Address Fax Number:
859-384-5261
Provider Enumeration Date:
07/21/2005