Provider First Line Business Practice Location Address:
200 MEDICAL VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-9286
Provider Business Practice Location Address Fax Number:
859-578-5975
Provider Enumeration Date:
04/04/2018