Provider First Line Business Practice Location Address: 
4207 DIXIE HWY
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
ELSMERE
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
41018-1817
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-342-6300
    Provider Business Practice Location Address Fax Number: 
859-342-6300
    Provider Enumeration Date: 
06/07/2011