Provider First Line Business Practice Location Address:
3198 CUSTER DR STE 100
Provider Second Line Business Practice Location Address:
SOUTHSIDE CHIROPRACTIC PSC
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40517-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-373-0800
Provider Business Practice Location Address Fax Number:
859-255-4104
Provider Enumeration Date:
10/17/2006