Provider First Line Business Practice Location Address:
1415 MAIN STREET
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:
40065-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-4613
Provider Business Practice Location Address Fax Number:
502-633-0048
Provider Enumeration Date:
04/22/2008