Provider First Line Business Practice Location Address:
7807 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
STE 203
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-9555
Provider Business Practice Location Address Fax Number:
502-423-7701
Provider Enumeration Date:
08/30/2006