Provider First Line Business Practice Location Address:
1038 WASHINGTON ST
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:
40065-1331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-633-9733
Provider Business Practice Location Address Fax Number:
502-633-1371
Provider Enumeration Date:
11/03/2005