Provider First Line Business Practice Location Address:
12420 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:
40243-1419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-1354
Provider Business Practice Location Address Fax Number:
502-244-0463
Provider Enumeration Date:
11/17/2008