Provider First Line Business Practice Location Address:
275 E MAIN ST
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:
40601-2321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-296-1989
Provider Business Practice Location Address Fax Number:
606-668-3435
Provider Enumeration Date:
10/22/2008