Provider First Line Business Practice Location Address:
621 NORTH 3RD 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:
40004-1750
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-5901
Provider Business Practice Location Address Fax Number:
502-348-7260
Provider Enumeration Date:
10/21/2008