Provider First Line Business Practice Location Address:
913 TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40071-8713
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-477-1973
Provider Business Practice Location Address Fax Number:
502-477-1975
Provider Enumeration Date:
06/05/2012