Provider First Line Business Practice Location Address:
12700 SHELBYVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40243-1576
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-254-8880
Provider Business Practice Location Address Fax Number:
502-633-3634
Provider Enumeration Date:
11/10/2005