Provider First Line Business Practice Location Address:
11939 TAYLOR MILL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41051-9762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-363-1222
Provider Business Practice Location Address Fax Number:
859-261-2881
Provider Enumeration Date:
02/09/2006