Provider First Line Business Practice Location Address:
7519 OUTER LOOP
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:
40228-1726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-231-2424
Provider Business Practice Location Address Fax Number:
502-882-7750
Provider Enumeration Date:
10/27/2005