Provider First Line Business Practice Location Address:
1301 ATKINSON HILL AVE
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:
40004-7770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-4929
Provider Business Practice Location Address Fax Number:
502-348-2852
Provider Enumeration Date:
06/30/2005