Provider First Line Business Practice Location Address:
11517 SHELBYVILLE RD STE B
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:
40243-1378
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-413-1992
Provider Business Practice Location Address Fax Number:
502-365-3992
Provider Enumeration Date:
01/07/2026