Provider First Line Business Practice Location Address:
550 W DIXIE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-2468
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-982-3089
Provider Business Practice Location Address Fax Number:
270-982-3096
Provider Enumeration Date:
09/29/2011