Provider First Line Business Practice Location Address:
12001 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE C
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:
502-244-5044
Provider Business Practice Location Address Fax Number:
502-244-5190
Provider Enumeration Date:
03/08/2007