Provider First Line Business Practice Location Address:
13125 EASTPOINT PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-3168
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-1135
Provider Business Practice Location Address Fax Number:
502-253-1136
Provider Enumeration Date:
09/26/2006