Provider First Line Business Practice Location Address:
12101 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-7037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/12/2021