Provider First Line Business Practice Location Address:
359 OLD US HIGHWAY 421
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40962-7538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-234-5600
Provider Business Practice Location Address Fax Number:
859-234-5606
Provider Enumeration Date:
11/18/2013