Provider First Line Business Practice Location Address: 
3401 YORKSHIRE MEDICAL PARK
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
LEXINGTON
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40509-2513
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-263-5140
    Provider Business Practice Location Address Fax Number: 
859-263-5141
    Provider Enumeration Date: 
06/07/2010