Provider First Line Business Practice Location Address:
11102 HIGHWAY 44 EAST
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:
40047-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-904-9933
Provider Business Practice Location Address Fax Number:
502-904-9935
Provider Enumeration Date:
02/13/2006