Provider First Line Business Practice Location Address:
101 OLD SEVEN MILE PIKE
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:
40065-8816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-5725
Provider Business Practice Location Address Fax Number:
502-633-5949
Provider Enumeration Date:
09/28/2006