Provider First Line Business Practice Location Address:
1717 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-2766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7453
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2010