Provider First Line Business Practice Location Address:
1100 US HIGHWAY 127 S STE A3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-229-7372
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2026