Provider First Line Business Practice Location Address:
275 EAST MAIN STREET
Provider Second Line Business Practice Location Address:
HS1WB
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40621-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-564-7213
Provider Business Practice Location Address Fax Number:
502-564-0919
Provider Enumeration Date:
10/24/2007