Provider First Line Business Practice Location Address:
601 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:
40601-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-661-1274
Provider Business Practice Location Address Fax Number:
502-661-1293
Provider Enumeration Date:
04/06/2020