Provider First Line Business Practice Location Address:
706 MAIN 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:
40065-1240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-1530
Provider Business Practice Location Address Fax Number:
502-633-4196
Provider Enumeration Date:
08/05/2007