Provider First Line Business Practice Location Address:
13332 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:
40223-3936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-281-4900
Provider Business Practice Location Address Fax Number:
502-281-4901
Provider Enumeration Date:
12/02/2020