Provider First Line Business Practice Location Address:
176 BARNWOOD DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-2500
Provider Business Practice Location Address Fax Number:
859-331-2532
Provider Enumeration Date:
11/29/2005