Provider First Line Business Practice Location Address:
519 W FOURTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40508-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-252-8636
Provider Business Practice Location Address Fax Number:
859-252-5546
Provider Enumeration Date:
09/15/2011