Provider First Line Business Practice Location Address:
3934 DIXIE HWY
Provider Second Line Business Practice Location Address:
STE 505
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-4163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-449-1270
Provider Business Practice Location Address Fax Number:
502-449-1271
Provider Enumeration Date:
12/18/2007