Provider First Line Business Practice Location Address:
14020 E HIGHWAY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40146-7166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-547-2855
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2018