Provider First Line Business Practice Location Address:
2161 LEXINGTON ROAD
Provider Second Line Business Practice Location Address:
SUITE #1
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-624-8647
Provider Business Practice Location Address Fax Number:
859-624-5044
Provider Enumeration Date:
07/21/2005