Provider First Line Business Practice Location Address:
1154 LEXINGTON RD
Provider Second Line Business Practice Location Address:
STE 2
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-863-2207
Provider Business Practice Location Address Fax Number:
502-863-3700
Provider Enumeration Date:
04/30/2007