Provider First Line Business Practice Location Address:
10718 SHELBYVILLE 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:
40243-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-4661
Provider Business Practice Location Address Fax Number:
502-245-4610
Provider Enumeration Date:
03/22/2007