Provider First Line Business Practice Location Address:
8403 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:
40222-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-9555
Provider Business Practice Location Address Fax Number:
502-694-4470
Provider Enumeration Date:
07/01/2015