Provider First Line Business Practice Location Address:
9900 SHELBYVILLE RD STE 8
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:
40223-2965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-915-8796
Provider Business Practice Location Address Fax Number:
502-805-0765
Provider Enumeration Date:
01/12/2015