Provider First Line Business Practice Location Address:
1578 HIGHWAY 44 EAST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
SHEPHERDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-5200
Provider Business Practice Location Address Fax Number:
502-543-5244
Provider Enumeration Date:
06/14/2006