Provider First Line Business Practice Location Address:
2689 FRANKFORT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-8611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-537-9779
Provider Business Practice Location Address Fax Number:
502-868-9312
Provider Enumeration Date:
02/10/2016