Provider First Line Business Practice Location Address:
715 SHAKER DR
Provider Second Line Business Practice Location Address:
STE 139 PHYSICIANS MALL
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-277-1139
Provider Business Practice Location Address Fax Number:
859-373-9427
Provider Enumeration Date:
03/14/2007