Provider First Line Business Practice Location Address:
130 JOE B. HALL AVE
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:
40165-0690
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-6447
Provider Business Practice Location Address Fax Number:
502-955-9605
Provider Enumeration Date:
03/08/2007