Provider First Line Business Practice Location Address:
4122 SHELBYVILLE ROAD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-6930
Provider Business Practice Location Address Fax Number:
502-894-9044
Provider Enumeration Date:
08/23/2007