Provider First Line Business Practice Location Address:
715 SHAKER DR
Provider Second Line Business Practice Location Address:
STE 101 PAIN MANAGEMENT MEDICINE
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:
859-275-4878
Provider Business Practice Location Address Fax Number:
859-276-5400
Provider Enumeration Date:
01/31/2006