Provider First Line Business Practice Location Address:
1 MEDICAL VILLAGE DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDGEWOOD
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41017-3403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-301-5652
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/14/2005