Provider First Line Business Practice Location Address:
306 W 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:
40601-1895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-385-2748
Provider Business Practice Location Address Fax Number:
502-996-8400
Provider Enumeration Date:
08/23/2011