Provider First Line Business Practice Location Address:
1523 S SHELBY ST
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:
40217-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-913-7200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/20/2012