Provider First Line Business Practice Location Address:
120 E ADAMS ST
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-3281
Provider Business Practice Location Address Fax Number:
502-225-5796
Provider Enumeration Date:
06/28/2006