Provider First Line Business Practice Location Address:
130 VINE STREET
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:
40165-0690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-8600
Provider Business Practice Location Address Fax Number:
502-589-8771
Provider Enumeration Date:
06/12/2008