Provider First Line Business Practice Location Address:
1154 LEXINGTON RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9330
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
138-347-0635
Provider Business Practice Location Address Fax Number:
513-873-1567
Provider Enumeration Date:
01/02/2015