Provider First Line Business Practice Location Address:
618 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-225-0666
Provider Business Practice Location Address Fax Number:
502-265-0731
Provider Enumeration Date:
03/17/2008