Provider First Line Business Practice Location Address:
12400 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:
40243-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-883-2218
Provider Business Practice Location Address Fax Number:
502-883-2031
Provider Enumeration Date:
02/02/2006