Provider First Line Business Practice Location Address:
1140 LEXINGTON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-868-1100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2006