Provider First Line Business Practice Location Address:
18 ALEXANDER AVE
Provider Second Line Business Practice Location Address:
UNIT 1
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40006-1114
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-255-0222
Provider Business Practice Location Address Fax Number:
888-310-2675
Provider Enumeration Date:
12/04/2006