Provider First Line Business Practice Location Address: 
334 THOMAS MORE PKWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
CRESTVIEW HILLS
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
41017-3464
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-578-3400
    Provider Business Practice Location Address Fax Number: 
859-957-0055
    Provider Enumeration Date: 
10/19/2006