Provider First Line Business Practice Location Address:
9800 SHELBYVILLE RD STE 202
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:
40223-5440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-536-7224
Provider Business Practice Location Address Fax Number:
888-419-6943
Provider Enumeration Date:
01/15/2015