Provider First Line Business Practice Location Address:
1005 HIGHWAY 22 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-9041
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-547-1010
Provider Business Practice Location Address Fax Number:
859-567-1253
Provider Enumeration Date:
10/26/2010