Provider First Line Business Practice Location Address:
300 HOPE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-7757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-926-2484
Provider Business Practice Location Address Fax Number:
270-685-6011
Provider Enumeration Date:
11/19/2012