Provider First Line Business Practice Location Address:
1717 DIXIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 387
Provider Business Practice Location Address City Name:
FORT WRIGHT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-358-8648
Provider Business Practice Location Address Fax Number:
877-877-6875
Provider Enumeration Date:
09/19/2025