Provider First Line Business Practice Location Address:
496 SOUTHLAND DR
Provider Second Line Business Practice Location Address:
HEALTHFIRST BLUEGRASS DENTAL DEPARTMENT
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-512-7009
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006