Provider First Line Business Practice Location Address:
2168 FRANKFORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9434
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-3663
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2007