Provider First Line Business Practice Location Address:
1138 LEXINGTON RD
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-867-0222
Provider Business Practice Location Address Fax Number:
502-867-0420
Provider Enumeration Date:
05/03/2013