Provider First Line Business Practice Location Address:
719 FEHR RD
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:
40206-2987
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-895-8105
Provider Business Practice Location Address Fax Number:
502-895-8105
Provider Enumeration Date:
09/09/2009