Provider First Line Business Practice Location Address:
5694 SHEPHERDSVILLE 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:
40228-1014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-266-5001
Provider Business Practice Location Address Fax Number:
502-266-5035
Provider Enumeration Date:
10/19/2006