Provider First Line Business Practice Location Address:
506 SHELBY STREET
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:
40601-2824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-875-4499
Provider Business Practice Location Address Fax Number:
502-875-2655
Provider Enumeration Date:
12/05/2006