Provider First Line Business Practice Location Address:
5135 DIXIE HWY
Provider Second Line Business Practice Location Address:
STE 22
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-448-0070
Provider Business Practice Location Address Fax Number:
502-448-4646
Provider Enumeration Date:
02/15/2007