Provider First Line Business Practice Location Address:
12910 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:
40243-1593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-259-9183
Provider Business Practice Location Address Fax Number:
502-254-4069
Provider Enumeration Date:
10/17/2014