Provider First Line Business Practice Location Address:
3221 E HIGHWAY 22
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40068-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-216-8464
Provider Business Practice Location Address Fax Number:
502-222-5698
Provider Enumeration Date:
08/15/2013