Provider First Line Business Practice Location Address:
3503 POPLAR LEVEL 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:
40213-1009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-371-1002
Provider Business Practice Location Address Fax Number:
502-371-1005
Provider Enumeration Date:
09/20/2006