Provider First Line Business Practice Location Address:
2225 LAWRENCEBURG RD
Provider Second Line Business Practice Location Address:
BUILDING A SUITE 4
Provider Business Practice Location Address City Name:
FRANKFORT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40601-9128
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-352-7272
Provider Business Practice Location Address Fax Number:
502-352-7273
Provider Enumeration Date:
09/27/2012