Provider First Line Business Practice Location Address:
4600 SHELBYVILLE RD STE 220
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:
40207-3398
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-7546
Provider Business Practice Location Address Fax Number:
502-897-7055
Provider Enumeration Date:
07/18/2005