Provider First Line Business Practice Location Address:
4141 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:
40207-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-489-5022
Provider Business Practice Location Address Fax Number:
502-489-5066
Provider Enumeration Date:
12/11/2006