Provider First Line Business Practice Location Address:
9509 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
STE. 201A
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-9290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-329-0484
Provider Business Practice Location Address Fax Number:
502-228-6917
Provider Enumeration Date:
05/27/2006