Provider First Line Business Practice Location Address:
221 LEXINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40444-1184
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-792-3691
Provider Business Practice Location Address Fax Number:
859-885-5487
Provider Enumeration Date:
02/18/2007