Provider First Line Business Practice Location Address:
3001 W HIGHWAY 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40032-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-9441
Provider Business Practice Location Address Fax Number:
502-222-7760
Provider Enumeration Date:
09/27/2012