Provider First Line Business Practice Location Address:
201 S 5TH ST
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:
40004-1142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-5968
Provider Business Practice Location Address Fax Number:
502-349-0963
Provider Enumeration Date:
07/05/2005