Provider First Line Business Practice Location Address:
2195 HARRODSBURG RD STE 2
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:
40504-3516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-3376
Provider Business Practice Location Address Fax Number:
859-323-0350
Provider Enumeration Date:
02/22/2006