Provider First Line Business Practice Location Address:
12975 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
T2728
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-2405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-992-1238
Provider Business Practice Location Address Fax Number:
502-992-1248
Provider Enumeration Date:
06/13/2011