Provider First Line Business Practice Location Address:
649 CHAMBERLIN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-214-7440
Provider Business Practice Location Address Fax Number:
502-875-1686
Provider Enumeration Date:
11/12/2007