Provider First Line Business Practice Location Address:
1705 N DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-5506
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-769-2020
Provider Business Practice Location Address Fax Number:
502-736-4490
Provider Enumeration Date:
07/07/2005