Provider First Line Business Practice Location Address:
10000 BROWNSBORO RD
Provider Second Line Business Practice Location Address:
STE 6
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-429-5005
Provider Business Practice Location Address Fax Number:
502-426-0733
Provider Enumeration Date:
08/24/2005