Provider First Line Business Practice Location Address:
146 DEWEESE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40507-1921
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-785-8585
Provider Business Practice Location Address Fax Number:
859-888-9980
Provider Enumeration Date:
09/28/2020