Provider First Line Business Practice Location Address:
9800 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE #220
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-2977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-429-8585
Provider Business Practice Location Address Fax Number:
502-753-0889
Provider Enumeration Date:
07/26/2005