Provider First Line Business Practice Location Address:
112 S VINSON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41230-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-2692
Provider Business Practice Location Address Fax Number:
859-277-9275
Provider Enumeration Date:
03/06/2025