Provider First Line Business Practice Location Address:
1088 HWY 490
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST BERNSTADT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-843-2211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/21/2006