Provider First Line Business Practice Location Address:
1236 PARIS PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40324-9701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-370-7229
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2012