Provider First Line Business Practice Location Address:
120 W STEPHEN FOSTER AVE STE 104
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:
40004-1457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-348-5800
Provider Business Practice Location Address Fax Number:
502-722-2116
Provider Enumeration Date:
10/25/2005