Provider First Line Business Practice Location Address:
12121 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 107
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-6500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/19/2010