Provider First Line Business Practice Location Address:
4505 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-3325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-0911
Provider Business Practice Location Address Fax Number:
502-895-0998
Provider Enumeration Date:
08/17/2006