Provider First Line Business Practice Location Address:
138 LEADER AVE OFC 208
Provider Second Line Business Practice Location Address:
DEPT. OF PEDIATRICS, DIVISION OF GASTROENTEROLOGY
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40506-9983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-218-1676
Provider Business Practice Location Address Fax Number:
859-257-7799
Provider Enumeration Date:
10/13/2006