Provider First Line Business Practice Location Address:
8517 PRESTON HWY
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:
40219-5301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-966-4367
Provider Business Practice Location Address Fax Number:
502-966-4001
Provider Enumeration Date:
11/14/2006