Provider First Line Business Practice Location Address:
11800 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1476
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-1354
Provider Business Practice Location Address Fax Number:
502-244-0463
Provider Enumeration Date:
02/19/2009