Provider First Line Business Practice Location Address:
1227 US 127 S
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:
40601-4329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-875-2550
Provider Business Practice Location Address Fax Number:
502-875-5094
Provider Enumeration Date:
10/23/2006