Provider First Line Business Practice Location Address:
820 NEW GLENDALE RD
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:
42701-8372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-766-5283
Provider Business Practice Location Address Fax Number:
270-766-5287
Provider Enumeration Date:
04/17/2007