Provider First Line Business Practice Location Address:
1210 KY HIGHWAY 36 E STE 2A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CYNTHIANA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41031-7492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-298-2650
Provider Business Practice Location Address Fax Number:
859-234-0530
Provider Enumeration Date:
07/13/2014