Provider First Line Business Practice Location Address:
3005 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-578-9191
Provider Business Practice Location Address Fax Number:
859-578-9276
Provider Enumeration Date:
06/10/2011