Provider First Line Business Practice Location Address:
252 E HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40507-1422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-554-5844
Provider Business Practice Location Address Fax Number:
866-907-9419
Provider Enumeration Date:
05/31/2007