Provider First Line Business Practice Location Address:
9812 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-2906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-0509
Provider Business Practice Location Address Fax Number:
502-423-1599
Provider Enumeration Date:
02/28/2013