Provider First Line Business Practice Location Address:
12937 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-254-9881
Provider Business Practice Location Address Fax Number:
502-254-9265
Provider Enumeration Date:
05/09/2007