Provider First Line Business Practice Location Address:
100 CARMEL MANOR ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT. THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075-2395
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-781-5111
Provider Business Practice Location Address Fax Number:
859-781-2337
Provider Enumeration Date:
10/05/2005