Provider First Line Business Practice Location Address:
120 S SALEM DR
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:
40004-1798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-286-9770
Provider Business Practice Location Address Fax Number:
502-849-0880
Provider Enumeration Date:
03/16/2011