Provider First Line Business Practice Location Address:
107 FRAZIER COURT GEORGETOWN KY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-316-9520
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2026