Provider First Line Business Practice Location Address:
9110 NATIONAL TURNPIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRDALE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-485-8748
Provider Business Practice Location Address Fax Number:
502-485-6391
Provider Enumeration Date:
02/23/2007