Provider First Line Business Practice Location Address:
101 MEDICAL HEIGHTS DR STE D
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:
40601-4137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-226-7054
Provider Business Practice Location Address Fax Number:
502-226-7055
Provider Enumeration Date:
10/20/2005