Provider First Line Business Practice Location Address:
1955 DIXIE HWY STE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-2792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-6255
Provider Business Practice Location Address Fax Number:
859-547-1197
Provider Enumeration Date:
07/24/2014