Provider First Line Business Practice Location Address:
1150 LEXINGTON RD
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:
40324-8300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-562-8599
Provider Business Practice Location Address Fax Number:
859-257-1214
Provider Enumeration Date:
10/03/2022