Provider First Line Business Practice Location Address:
7321 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
STE 100 1/2
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-230-7111
Provider Business Practice Location Address Fax Number:
502-331-6062
Provider Enumeration Date:
01/29/2010