Provider First Line Business Practice Location Address:
11373 S PRESTON HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEBANON JUNCTION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40150-8472
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-833-2619
Provider Business Practice Location Address Fax Number:
502-833-3655
Provider Enumeration Date:
12/15/2005