Provider First Line Business Practice Location Address:
1183 STANFORD RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40444-9567
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-792-4236
Provider Business Practice Location Address Fax Number:
859-792-6033
Provider Enumeration Date:
06/08/2007