Provider First Line Business Practice Location Address:
100 ST. LUKE PL
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-7900
Provider Business Practice Location Address Fax Number:
502-863-0094
Provider Enumeration Date:
02/02/2007