Provider First Line Business Practice Location Address:
9800 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-429-0526
Provider Business Practice Location Address Fax Number:
502-429-0532
Provider Enumeration Date:
04/22/2011