Provider First Line Business Practice Location Address:
11601 SHELBYVILLE RD., SUITE A
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:
40243-1309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-690-2410
Provider Business Practice Location Address Fax Number:
502-690-2219
Provider Enumeration Date:
08/13/2015