Provider First Line Business Practice Location Address:
125 HOLMES ST
Provider Second Line Business Practice Location Address:
STATE OFFICE BUILDING ANNEX, SUITE 300
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-564-7910
Provider Business Practice Location Address Fax Number:
502-696-3806
Provider Enumeration Date:
04/11/2007