Provider First Line Business Practice Location Address:
10002 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUTIE 110
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-2979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-6446
Provider Business Practice Location Address Fax Number:
502-254-2198
Provider Enumeration Date:
03/13/2007