Provider First Line Business Practice Location Address:
110 S SALEM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARDSTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-349-4745
Provider Business Practice Location Address Fax Number:
502-348-3400
Provider Enumeration Date:
02/14/2007