Provider First Line Business Practice Location Address:
1578 HIGHWAY 44 E UNIT 2
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:
40165-7172
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-921-4161
Provider Business Practice Location Address Fax Number:
502-921-4165
Provider Enumeration Date:
04/23/2010