Provider First Line Business Practice Location Address:
3001 KY-146 W HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-367-5690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/06/2026