Provider First Line Business Practice Location Address:
1604 HARRODSBURG ROAD
Provider Second Line Business Practice Location Address:
SUITE B
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:
714-441-5888
Provider Business Practice Location Address Fax Number:
888-349-8837
Provider Enumeration Date:
06/19/2006