Provider First Line Business Practice Location Address: 
1900 RICHMOND RD
    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: 
40502-1204
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
859-266-2101
    Provider Business Practice Location Address Fax Number: 
859-268-5636
    Provider Enumeration Date: 
02/16/2007