Provider First Line Business Practice Location Address:
1403 LOUISVILLE RD
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:
40601-3914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-352-6931
Provider Business Practice Location Address Fax Number:
502-352-1082
Provider Enumeration Date:
02/25/2008