Provider First Line Business Practice Location Address:
10306 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:
40223-2914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-7334
Provider Business Practice Location Address Fax Number:
502-245-7187
Provider Enumeration Date:
11/09/2023