Provider First Line Business Practice Location Address:
6225 W HWY 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-241-8208
Provider Business Practice Location Address Fax Number:
502-241-2428
Provider Enumeration Date:
05/04/2007