Provider First Line Business Practice Location Address:
6402 W HIGHWAY 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRESTWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40014-9508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-243-4280
Provider Business Practice Location Address Fax Number:
502-243-4279
Provider Enumeration Date:
04/16/2009