Provider First Line Business Practice Location Address:
120 LIFE CARE WAY
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:
40004-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-422-0348
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2007