Provider First Line Business Practice Location Address:
1642 HARRODSBURG RD
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:
40504-3706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-381-3563
Provider Business Practice Location Address Fax Number:
859-381-3565
Provider Enumeration Date:
11/27/2007