Provider First Line Business Practice Location Address:
662 E MAIN 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:
40601-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-223-2827
Provider Business Practice Location Address Fax Number:
502-227-2026
Provider Enumeration Date:
05/15/2007