Provider First Line Business Practice Location Address:
108 PLAZA DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-9032
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-859-3101
Provider Business Practice Location Address Fax Number:
502-859-3102
Provider Enumeration Date:
10/26/2006