Provider First Line Business Practice Location Address:
6225 W. HWY 146, STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-822-3499
Provider Business Practice Location Address Fax Number:
502-822-1564
Provider Enumeration Date:
12/07/2006