Provider First Line Business Practice Location Address:
5594 SHEPHERDSVILLE 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:
40228-1012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-961-8429
Provider Business Practice Location Address Fax Number:
502-961-8538
Provider Enumeration Date:
07/10/2006