Provider First Line Business Practice Location Address:
100 TRADE ST
Provider Second Line Business Practice Location Address:
C/O LFUCG HEALTH CLINIC
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40511-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-425-2555
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2011