Provider First Line Business Practice Location Address:
6000 BROWNSBORO PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-899-9560
Provider Business Practice Location Address Fax Number:
502-899-9561
Provider Enumeration Date:
11/14/2005