Provider First Line Business Practice Location Address:
163 SOUTH ENGLISH STATION ROAD
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:
40245-3996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-882-2063
Provider Business Practice Location Address Fax Number:
502-882-2067
Provider Enumeration Date:
08/29/2005