Provider First Line Business Practice Location Address:
965 HIGHWAY 127 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWENTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40359-9302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-484-3046
Provider Business Practice Location Address Fax Number:
502-484-1032
Provider Enumeration Date:
08/05/2013