Provider First Line Business Practice Location Address:
3808 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:
40218-2579
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-5563
Provider Business Practice Location Address Fax Number:
502-459-5513
Provider Enumeration Date:
10/14/2013