Provider First Line Business Practice Location Address:
2494 PLUM RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40071-9207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-354-3123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2014