Provider First Line Business Practice Location Address:
130 HOPE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-439-2248
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/14/2020