Provider First Line Business Practice Location Address:
2010 S HURSTBOURNE PKWY
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:
40220-4207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-491-0054
Provider Business Practice Location Address Fax Number:
502-491-9618
Provider Enumeration Date:
03/29/2007