Provider First Line Business Practice Location Address:
13 VILLAGE PLAZA
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-8700
Provider Business Practice Location Address Fax Number:
502-896-0813
Provider Enumeration Date:
09/13/2006