Provider First Line Business Practice Location Address:
12955 SHELBYVILLE RD STE 2
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:
40243-1538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-4301
Provider Business Practice Location Address Fax Number:
502-394-3632
Provider Enumeration Date:
04/16/2021