Provider First Line Business Practice Location Address:
10224 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:
40223-2978
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-1237
Provider Business Practice Location Address Fax Number:
502-245-2231
Provider Enumeration Date:
03/06/2007