Provider First Line Business Practice Location Address:
150 FRANKFORT RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065-9433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-647-5468
Provider Business Practice Location Address Fax Number:
502-647-7134
Provider Enumeration Date:
10/11/2006