Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DR FL 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-2445
Provider Business Practice Location Address Fax Number:
859-301-2566
Provider Enumeration Date:
03/07/2011