Provider First Line Business Practice Location Address:
2120 NEWBURG RD
Provider Second Line Business Practice Location Address:
STE. 414
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40205-1867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-452-9597
Provider Business Practice Location Address Fax Number:
502-429-3916
Provider Enumeration Date:
09/04/2006