Provider First Line Business Practice Location Address:
1A HAWTHORN HL
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:
40204-2491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-6662
Provider Business Practice Location Address Fax Number:
502-451-6665
Provider Enumeration Date:
08/02/2006