Provider First Line Business Practice Location Address:
202 S 4TH 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:
40004-1008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-1054
Provider Business Practice Location Address Fax Number:
502-348-1056
Provider Enumeration Date:
06/08/2011