Provider First Line Business Practice Location Address:
3970 BARDSTOWN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELIZABETHTOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42701-9787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-737-7227
Provider Business Practice Location Address Fax Number:
270-858-4029
Provider Enumeration Date:
11/28/2018