Provider First Line Business Practice Location Address:
8401 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-403-1086
Provider Business Practice Location Address Fax Number:
502-403-1074
Provider Enumeration Date:
04/15/2007