Provider First Line Business Practice Location Address:
7410 NEW LAGRANGE ROAD
Provider Second Line Business Practice Location Address:
SUITE 304
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-1330
Provider Business Practice Location Address Fax Number:
502-426-1337
Provider Enumeration Date:
08/30/2006