Provider First Line Business Practice Location Address:
10412 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:
40223-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-3350
Provider Business Practice Location Address Fax Number:
502-425-3789
Provider Enumeration Date:
11/30/2006