Provider First Line Business Practice Location Address:
130 DUDLEY PIKE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-2396
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-341-7170
Provider Business Practice Location Address Fax Number:
859-341-7173
Provider Enumeration Date:
08/05/2014