Provider First Line Business Practice Location Address:
105 LAWSON DR STE 4
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9696
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-642-5400
Provider Business Practice Location Address Fax Number:
502-642-5411
Provider Enumeration Date:
05/06/2019