Provider First Line Business Practice Location Address:
207 E CAMPBELL ST
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:
40601-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-669-3946
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/29/2022