Provider First Line Business Practice Location Address:
121 S SALEM DRIVE
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:
40004-1762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-610-0151
Provider Business Practice Location Address Fax Number:
502-350-1151
Provider Enumeration Date:
05/10/2007