Provider First Line Business Practice Location Address:
857 KENTUCKY ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065-9257
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-638-2546
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006