Provider First Line Business Practice Location Address:
12312A SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-471-8630
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/22/2007