Provider First Line Business Practice Location Address: 
740 S LIMESTONE KY CLINIC K454
    Provider Second Line Business Practice Location Address: 
UNIVERSITY OF KENTUCKY - DIVISION OF PLASTIC SURGERY
    Provider Business Practice Location Address City Name: 
LEXINGTON
    Provider Business Practice Location Address State Name: 
KY
    Provider Business Practice Location Address Postal Code: 
40536-0284
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-323-1293
    Provider Business Practice Location Address Fax Number: 
859-323-3823
    Provider Enumeration Date: 
03/03/2006