Provider First Line Business Practice Location Address:
1506 N DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-2609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-765-2244
Provider Business Practice Location Address Fax Number:
270-765-2485
Provider Enumeration Date:
04/13/2006