Provider First Line Business Practice Location Address:
9409 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:
40222-5157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-588-0740
Provider Business Practice Location Address Fax Number:
502-588-7825
Provider Enumeration Date:
09/14/2021