Provider First Line Business Practice Location Address:
230 S MARTIN LUTHER KING BLVD
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:
40508-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-255-6640
Provider Business Practice Location Address Fax Number:
859-253-4786
Provider Enumeration Date:
06/27/2006