Provider First Line Business Practice Location Address:
2321 LIME KILN LN.
Provider Second Line Business Practice Location Address:
UNIT B
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:
502-526-8766
Provider Business Practice Location Address Fax Number:
888-972-1620
Provider Enumeration Date:
08/29/2013