Provider First Line Business Practice Location Address:
1156 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:
40324-8808
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-9703
Provider Business Practice Location Address Fax Number:
502-863-9778
Provider Enumeration Date:
02/16/2007