Provider First Line Business Practice Location Address:
9745 US HIGHWAY 127 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41086-9049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-681-5882
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2026