Provider First Line Business Practice Location Address:
13913 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:
40245-3905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-3112
Provider Business Practice Location Address Fax Number:
502-245-3150
Provider Enumeration Date:
11/01/2006