Provider First Line Business Practice Location Address:
10510 LA GRANGE 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:
40223-1277
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-7078
Provider Business Practice Location Address Fax Number:
502-253-7608
Provider Enumeration Date:
02/02/2006