Provider First Line Business Practice Location Address:
1604 LOUISVILLE RD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-352-2555
Provider Business Practice Location Address Fax Number:
502-352-2556
Provider Enumeration Date:
09/20/2010