Provider First Line Business Practice Location Address:
719 BURKS BRANCH 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:
502-633-2760
Provider Business Practice Location Address Fax Number:
502-633-7205
Provider Enumeration Date:
06/13/2007