Provider First Line Business Practice Location Address:
8403 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:
40222-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-5555
Provider Business Practice Location Address Fax Number:
502-423-7701
Provider Enumeration Date:
10/17/2006