Provider First Line Business Practice Location Address:
225 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE 265, CLARK CLINIC B
Provider Business Practice Location Address City Name:
WINCHESTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40391-1156
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-745-1010
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/27/2005