Provider First Line Business Practice Location Address:
740 S LIMESTONE ST
Provider Second Line Business Practice Location Address:
E207 KENTUCKY CLINIC
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-9263
Provider Business Practice Location Address Fax Number:
859-323-3704
Provider Enumeration Date:
02/05/2008