Provider First Line Business Practice Location Address:
90 HOWARD DR
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:
40065-8138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-223-9074
Provider Business Practice Location Address Fax Number:
502-272-9175
Provider Enumeration Date:
08/26/2025