Provider First Line Business Practice Location Address:
12010 SHELBYVILLE RD STE 100
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:
40243-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-589-4671
Provider Business Practice Location Address Fax Number:
502-589-6584
Provider Enumeration Date:
09/12/2018