Provider First Line Business Practice Location Address:
615 11TH ST
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:
40065-1435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-692-2774
Provider Business Practice Location Address Fax Number:
270-692-3559
Provider Enumeration Date:
10/23/2019