Provider First Line Business Practice Location Address:
65 W A JENKINS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-8452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-769-8800
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2007