Provider First Line Business Practice Location Address:
1209 HIGHLAND AVE STE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41008-8820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-732-6420
Provider Business Practice Location Address Fax Number:
502-732-6424
Provider Enumeration Date:
02/20/2025