Provider First Line Business Practice Location Address:
405 N. LEXINGTON AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILMORE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40390
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-858-0282
Provider Business Practice Location Address Fax Number:
859-858-0250
Provider Enumeration Date:
12/31/2007