Provider First Line Business Practice Location Address:
115 SCOVELL HALL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40506-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-257-2519
Provider Business Practice Location Address Fax Number:
859-323-1095
Provider Enumeration Date:
03/07/2007