Provider First Line Business Practice Location Address:
80 E MAIN ST
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40071-8609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-8600
Provider Business Practice Location Address Fax Number:
502-589-8771
Provider Enumeration Date:
02/05/2013