Provider First Line Business Practice Location Address:
1026 HIGH 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:
40065-1308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-321-9129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2023