Provider First Line Business Practice Location Address:
1640 PEAKS MILL RD
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:
40601-8398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-229-1425
Provider Business Practice Location Address Fax Number:
502-352-1226
Provider Enumeration Date:
03/09/2011