Provider First Line Business Practice Location Address:
5202 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:
40213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-966-2148
Provider Business Practice Location Address Fax Number:
502-964-7500
Provider Enumeration Date:
11/24/2006