Provider First Line Business Practice Location Address:
107 NORTH 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-3202
Provider Business Practice Location Address Fax Number:
502-348-0321
Provider Enumeration Date:
09/27/2006