Provider First Line Business Practice Location Address:
1123 N BARDSTOWN RD UNIT 4
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:
40047-7844
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-2332
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2007