Provider First Line Business Practice Location Address:
2141 SPENCER CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-6742
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-7201
Provider Business Practice Location Address Fax Number:
502-222-7486
Provider Enumeration Date:
01/06/2020