Provider First Line Business Practice Location Address:
4230 N. PRESTON HWY.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-6516
Provider Business Practice Location Address Fax Number:
502-955-9004
Provider Enumeration Date:
10/03/2006