Provider First Line Business Practice Location Address: 
800 ROSE ST
    Provider Second Line Business Practice Location Address: 
ROOM HQ-101
    Provider Business Practice Location Address City Name: 
LEXINGTON
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40536-0293
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
502-758-9940
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
05/07/2013