Provider First Line Business Practice Location Address:
1136 SO. 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:
41075-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-441-8050
Provider Business Practice Location Address Fax Number:
859-491-8056
Provider Enumeration Date:
08/22/2006