Provider First Line Business Practice Location Address:
9509 US HIGHWAY 42 STE 102
Provider Second Line Business Practice Location Address:
PROSPECT POINT SHOPPING CENTER
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-9291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-228-3578
Provider Business Practice Location Address Fax Number:
502-228-3596
Provider Enumeration Date:
02/20/2007