Provider First Line Business Practice Location Address:
CLINIC #6205
Provider Second Line Business Practice Location Address:
10490 SHELBYVILLE ROAD
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-245-8853
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2021