Provider First Line Business Practice Location Address:
690 UNIVERSITY SHOPPING CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40475-2614
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-623-3412
Provider Business Practice Location Address Fax Number:
859-623-3365
Provider Enumeration Date:
12/07/2006