Provider First Line Business Practice Location Address:
47 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAYLORSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40071-8616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-477-2577
Provider Business Practice Location Address Fax Number:
502-477-5150
Provider Enumeration Date:
09/27/2021