Provider First Line Business Practice Location Address:
20 MEDICAL VILLAGE DR STE 103
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:
41017-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-6790
Provider Business Practice Location Address Fax Number:
859-301-6791
Provider Enumeration Date:
06/09/2020