Provider First Line Business Practice Location Address:
40 NORTH GRAND AVENUE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
FT THOMAS
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-781-2700
Provider Business Practice Location Address Fax Number:
859-781-2712
Provider Enumeration Date:
12/06/2007