Provider First Line Business Practice Location Address: 
UNIVERSITY OF KENTUCKY
    Provider Second Line Business Practice Location Address: 
800 ROSE STREET
    Provider Business Practice Location Address City Name: 
LEXINGTON
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40536
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
816-404-4862
    Provider Business Practice Location Address Fax Number: 
    Provider Enumeration Date: 
04/28/2015