Provider First Line Business Practice Location Address:
401 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40507-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-252-3554
Provider Business Practice Location Address Fax Number:
859-252-3555
Provider Enumeration Date:
02/27/2007