Provider First Line Business Practice Location Address:
201 CULPEPER ST
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:
40004-3227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-349-2009
Provider Business Practice Location Address Fax Number:
502-349-3090
Provider Enumeration Date:
10/27/2009