Provider First Line Business Practice Location Address:
4000 MORGAN RD
Provider Second Line Business Practice Location Address:
ROEDERER CORRECTIONAL COMPLEX
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-0069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-0173
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/28/2008