Provider First Line Business Practice Location Address:
4200 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-3956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-5446
Provider Business Practice Location Address Fax Number:
502-895-4497
Provider Enumeration Date:
10/31/2006