Provider First Line Business Practice Location Address:
502 MOUNT EDEN ROAD
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-1538
Provider Business Practice Location Address Fax Number:
502-633-9445
Provider Enumeration Date:
09/20/2006