Provider First Line Business Practice Location Address:
2655 BARDSTOWN RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST. CATHARINE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40061-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-841-6091
Provider Business Practice Location Address Fax Number:
859-481-6130
Provider Enumeration Date:
09/22/2023