Provider First Line Business Practice Location Address:
487N. BARDSTOWN ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT.WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-9111
Provider Business Practice Location Address Fax Number:
502-955-9111
Provider Enumeration Date:
12/13/2006