Provider First Line Business Practice Location Address:
10700 US HIGHWAY 42 REAR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-9347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-552-3435
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007