Provider First Line Business Practice Location Address:
4011 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:
40207-3122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-736-2169
Provider Business Practice Location Address Fax Number:
717-412-9573
Provider Enumeration Date:
04/18/2006