Provider First Line Business Practice Location Address:
89 C MICHAEL DAVENPORT BLVD
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-4481
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-227-2229
Provider Business Practice Location Address Fax Number:
502-227-1114
Provider Enumeration Date:
01/29/2008