Provider First Line Business Practice Location Address:
1002 LEXINGTON RD
Provider Second Line Business Practice Location Address:
STE 22-286
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-1463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-539-6492
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2010