Provider First Line Business Practice Location Address:
4383 OLD HARRODSBURG RD
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40513-8012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-312-4124
Provider Business Practice Location Address Fax Number:
859-312-4124
Provider Enumeration Date:
07/07/2008