Provider First Line Business Practice Location Address:
53 FARRA DR
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:
40444-9598
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-792-1845
Provider Business Practice Location Address Fax Number:
859-792-1846
Provider Enumeration Date:
07/20/2007