Provider First Line Business Practice Location Address:
1138 LEXINGTON RD STE 100
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:
40324-9673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-570-3732
Provider Business Practice Location Address Fax Number:
502-570-3735
Provider Enumeration Date:
07/03/2007