Provider First Line Business Practice Location Address:
120 E ADAMS ST STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-1278
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-7874
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/15/2007