Provider First Line Business Practice Location Address:
130 JOE B HALL AVE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-5447
Provider Business Practice Location Address Fax Number:
502-955-7036
Provider Enumeration Date:
09/08/2023