Provider First Line Business Practice Location Address:
5222 DIXIE 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:
40216-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-449-7995
Provider Business Practice Location Address Fax Number:
502-449-2028
Provider Enumeration Date:
08/31/2006