Provider First Line Business Practice Location Address:
6442 HIGHWAY 44 E STE 140
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:
40047-6707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-8881
Provider Business Practice Location Address Fax Number:
502-416-0748
Provider Enumeration Date:
09/02/2006