Provider First Line Business Practice Location Address:
1562 BARDSTOWN RD
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:
40205-1155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-6662
Provider Business Practice Location Address Fax Number:
502-451-6665
Provider Enumeration Date:
12/22/2006