Provider First Line Business Practice Location Address:
4149 SHELBYVILLE RD
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:
40207-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-753-2980
Provider Business Practice Location Address Fax Number:
502-753-2999
Provider Enumeration Date:
10/02/2017