Provider First Line Business Practice Location Address:
6500 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:
40219-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-5502
Provider Business Practice Location Address Fax Number:
502-721-8670
Provider Enumeration Date:
04/26/2006