Provider First Line Business Practice Location Address:
2601 KENTUCKY AVE MED PARK 1
Provider Second Line Business Practice Location Address:
STE 301
Provider Business Practice Location Address City Name:
PADUCH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-575-3113
Provider Business Practice Location Address Fax Number:
270-575-3135
Provider Enumeration Date:
06/23/2016