Provider First Line Business Practice Location Address:
1612 HIGHWAY 44 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHEPHERDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40165-6129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-208-9079
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2025