Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DR
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:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-8074
Provider Business Practice Location Address Fax Number:
859-301-4945
Provider Enumeration Date:
06/28/2005