Provider First Line Business Practice Location Address:
2815 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:
40205-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-456-1771
Provider Business Practice Location Address Fax Number:
502-451-4484
Provider Enumeration Date:
08/14/2007