Provider First Line Business Practice Location Address:
7900 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
STE. A15
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-5451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-327-8568
Provider Business Practice Location Address Fax Number:
502-327-0613
Provider Enumeration Date:
10/10/2006