Provider First Line Business Practice Location Address:
1191 BYPASS S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-9722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-839-7278
Provider Business Practice Location Address Fax Number:
502-839-7388
Provider Enumeration Date:
07/04/2005