Provider First Line Business Practice Location Address:
12001 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-1243
Provider Business Practice Location Address Fax Number:
502-245-1243
Provider Enumeration Date:
12/04/2006