Provider First Line Business Practice Location Address:
300 W US HWY 150 BYPASS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40069-8460
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-336-5475
Provider Business Practice Location Address Fax Number:
270-858-4029
Provider Enumeration Date:
12/05/2019