Provider First Line Business Practice Location Address:
2230 MARTIN LUTHER KING JR BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-1282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-435-6375
Provider Business Practice Location Address Fax Number:
859-267-1418
Provider Enumeration Date:
10/22/2025