Provider First Line Business Practice Location Address:
206A TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40071-8724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-354-9400
Provider Business Practice Location Address Fax Number:
502-354-9401
Provider Enumeration Date:
06/03/2011