Provider First Line Business Practice Location Address:
1309 SUITE H US HWY 127 SOUTH
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-875-0127
Provider Business Practice Location Address Fax Number:
502-875-0129
Provider Enumeration Date:
07/10/2006