Provider First Line Business Practice Location Address:
1825 HARRINGTON MILL 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:
40065-8747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-583-2158
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/12/2019