Provider First Line Business Practice Location Address:
2551 US HIGHWAY 27
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-732-5969
Provider Business Practice Location Address Fax Number:
502-732-8968
Provider Enumeration Date:
11/22/2010