Provider First Line Business Practice Location Address:
400 E MAIN ST
Provider Second Line Business Practice Location Address:
KY STATE UNIVERSITY, BETTY WHITE BUILDING
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-2334
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-564-4269
Provider Business Practice Location Address Fax Number:
502-564-9586
Provider Enumeration Date:
11/07/2007