Provider First Line Business Practice Location Address:
8013 NEW LAGRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-4868
Provider Business Practice Location Address Fax Number:
502-426-4869
Provider Enumeration Date:
02/08/2007