Provider First Line Business Practice Location Address:
809 LOUISVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-330-2808
Provider Business Practice Location Address Fax Number:
502-352-4417
Provider Enumeration Date:
08/02/2006