Provider First Line Business Practice Location Address:
4000 N DIXIE HWY
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-4650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-737-4280
Provider Business Practice Location Address Fax Number:
270-737-0582
Provider Enumeration Date:
11/21/2005