Provider First Line Business Practice Location Address:
115 HUSTON DR STE 2
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:
40165-7250
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-988-8979
Provider Business Practice Location Address Fax Number:
502-955-1205
Provider Enumeration Date:
06/24/2012