Provider First Line Business Practice Location Address:
624 CHAMBERLIN AVE
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:
40601-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-227-2285
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2008