Provider First Line Business Practice Location Address:
2529 SIX MILE LN
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-491-5560
Provider Business Practice Location Address Fax Number:
502-491-0214
Provider Enumeration Date:
01/07/2008