Provider First Line Business Practice Location Address:
BLUEGRASS FUNCTIONAL MEDICINE
Provider Second Line Business Practice Location Address:
841 CORPORATE DRIVE, SUITE 204
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-300-3007
Provider Business Practice Location Address Fax Number:
912-434-4931
Provider Enumeration Date:
09/04/2007