Provider First Line Business Practice Location Address:
3850 FRANKFORT RD
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:
40065-9407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-1007
Provider Business Practice Location Address Fax Number:
502-805-1511
Provider Enumeration Date:
03/03/2014