Provider First Line Business Practice Location Address:
181 HIGHWAY 44 E
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:
40165-6081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-543-3054
Provider Business Practice Location Address Fax Number:
502-543-3997
Provider Enumeration Date:
10/03/2006