Provider First Line Business Practice Location Address:
12911 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:
40243-1613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-254-1100
Provider Business Practice Location Address Fax Number:
502-254-7634
Provider Enumeration Date:
01/08/2007