Provider First Line Business Practice Location Address:
740 S LIMESTONE ST
Provider Second Line Business Practice Location Address:
KY CLINIC, ROOM J450
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-8325
Provider Business Practice Location Address Fax Number:
859-323-8179
Provider Enumeration Date:
03/02/2010