Provider First Line Business Practice Location Address:
120 W STEPHEN FOSTER AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004-1465
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:
502-348-9990
Provider Enumeration Date:
01/18/2013