Provider First Line Business Practice Location Address:
105 S 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-5454
Provider Business Practice Location Address Fax Number:
502-349-6190
Provider Enumeration Date:
12/04/2006