Provider First Line Business Practice Location Address:
18 CLINIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40361-2161
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-987-6810
Provider Business Practice Location Address Fax Number:
859-987-6812
Provider Enumeration Date:
09/11/2013