Provider First Line Business Practice Location Address:
153 E MAIN ST
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:
40071-8602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-477-8444
Provider Business Practice Location Address Fax Number:
502-477-9181
Provider Enumeration Date:
04/25/2013