Provider First Line Business Practice Location Address:
150 FRANKFORT RD STE 103
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:
40065-7401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-844-2888
Provider Business Practice Location Address Fax Number:
502-394-3650
Provider Enumeration Date:
07/19/2018