Provider First Line Business Practice Location Address:
201 MEDICAL VILLAGE DR
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:
41017-3407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-681-2241
Provider Business Practice Location Address Fax Number:
407-679-2779
Provider Enumeration Date:
10/03/2005