Provider First Line Business Practice Location Address:
238 BARNES ROAD
Provider Second Line Business Practice Location Address:
ST ELIZABETH GRANT COUNTY
Provider Business Practice Location Address City Name:
WILLIAMSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-9900
Provider Business Practice Location Address Fax Number:
859-341-1649
Provider Enumeration Date:
12/05/2006