Provider First Line Business Practice Location Address:
12981 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLETOWN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-736-9973
Provider Business Practice Location Address Fax Number:
502-736-9976
Provider Enumeration Date:
10/24/2012