Provider First Line Business Practice Location Address:
230 FRANKFORT ST
Provider Second Line Business Practice Location Address:
STE 5
Provider Business Practice Location Address City Name:
VERSAILLES
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-873-5743
Provider Business Practice Location Address Fax Number:
859-879-9582
Provider Enumeration Date:
06/12/2007