Provider First Line Business Practice Location Address:
4000 N DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-4649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-505-4183
Provider Business Practice Location Address Fax Number:
270-900-1238
Provider Enumeration Date:
10/01/2008