Provider First Line Business Practice Location Address:
12935 SHELBYVILLE ROAD STE 106
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-489-5002
Provider Business Practice Location Address Fax Number:
502-489-8002
Provider Enumeration Date:
08/01/2019