Provider First Line Business Practice Location Address:
102 N 3RD ST
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:
40004-1526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-9261
Provider Business Practice Location Address Fax Number:
502-348-3334
Provider Enumeration Date:
09/12/2006