Provider First Line Business Practice Location Address:
815 JOHN HARPER HWY
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
SHEPHERDSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40165-7463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-1449
Provider Business Practice Location Address Fax Number:
502-955-1471
Provider Enumeration Date:
09/07/2006