Provider First Line Business Practice Location Address:
112 FAIRFIELD HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40008-0484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-252-0056
Provider Business Practice Location Address Fax Number:
502-252-0058
Provider Enumeration Date:
06/08/2010