Provider First Line Business Practice Location Address:
4122 SHELBYVILLE RD STE A
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:
40207-3212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-805-3074
Provider Business Practice Location Address Fax Number:
502-251-0922
Provider Enumeration Date:
07/25/2024