Provider First Line Business Practice Location Address:
313 SAINT CLAIR ST
Provider Second Line Business Practice Location Address:
STE M
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-1819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-227-8299
Provider Business Practice Location Address Fax Number:
502-352-2454
Provider Enumeration Date:
09/07/2010