Provider First Line Business Practice Location Address:
9509 US HIGHWAY 42 STE 108
Provider Second Line Business Practice Location Address:
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:
502-709-4717
Provider Business Practice Location Address Fax Number:
502-709-4727
Provider Enumeration Date:
05/16/2007