Provider First Line Business Practice Location Address:
191 OUTER LOOP
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:
40214-5544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-361-2501
Provider Business Practice Location Address Fax Number:
502-367-0820
Provider Enumeration Date:
02/15/2010