Provider First Line Business Practice Location Address:
340 HIGHWAY 44 E
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:
40165-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-215-8422
Provider Business Practice Location Address Fax Number:
502-215-8373
Provider Enumeration Date:
11/29/2018