Provider First Line Business Practice Location Address:
1190 OLD SEVEN MILE PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065-8818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-4404
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2012