Provider First Line Business Practice Location Address:
14045 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:
40245-3907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-9343
Provider Business Practice Location Address Fax Number:
502-245-9352
Provider Enumeration Date:
12/28/2012