Provider First Line Business Practice Location Address:
3999 DUTCHMANS LN
Provider Second Line Business Practice Location Address:
MEDICAL PLAZA 1, SUITE 1H
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4744
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-7472
Provider Business Practice Location Address Fax Number:
502-636-7130
Provider Enumeration Date:
06/19/2008