Provider First Line Business Practice Location Address:
8761 US HIGHWAY 42
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
UNION
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41091-9315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-647-7780
Provider Business Practice Location Address Fax Number:
859-647-7716
Provider Enumeration Date:
05/07/2014