Provider First Line Business Practice Location Address:
1230 US HIGHWAY 127 S
Provider Second Line Business Practice Location Address:
SUITE 03
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-352-2512
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2010