Provider First Line Business Practice Location Address:
112 W HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40507-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-523-3009
Provider Business Practice Location Address Fax Number:
859-523-5007
Provider Enumeration Date:
05/25/2006