Provider First Line Business Practice Location Address:
238 SALT WELL RD
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:
40165-8288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-7580
Provider Business Practice Location Address Fax Number:
502-543-7244
Provider Enumeration Date:
11/02/2006