Provider First Line Business Practice Location Address:
152 N BUCKMAN ST
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:
40165-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-543-2202
Provider Business Practice Location Address Fax Number:
502-543-1040
Provider Enumeration Date:
08/12/2020