Provider First Line Business Practice Location Address:
213 MIDLAND BLVD
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:
40065-7791
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-647-0154
Provider Business Practice Location Address Fax Number:
502-633-4043
Provider Enumeration Date:
01/23/2020