Provider First Line Business Practice Location Address:
1100 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:
40601-2551
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-695-6750
Provider Business Practice Location Address Fax Number:
502-564-9640
Provider Enumeration Date:
03/22/2010