Provider First Line Business Practice Location Address:
1401 HARRODSBURG RD
Provider Second Line Business Practice Location Address:
STE B295
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504-1764
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-276-5349
Provider Business Practice Location Address Fax Number:
859-276-5340
Provider Enumeration Date:
05/24/2005