Provider First Line Business Practice Location Address:
8211 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:
40222-5421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-4915
Provider Business Practice Location Address Fax Number:
502-412-4917
Provider Enumeration Date:
04/11/2006