Provider First Line Business Practice Location Address:
208 BEVINS LN
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-6128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-4242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/21/2014