Provider First Line Business Practice Location Address:
1825 DIXIE HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011-2646
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-331-0370
Provider Business Practice Location Address Fax Number:
859-331-9728
Provider Enumeration Date:
09/02/2013