Provider First Line Business Practice Location Address:
4123 DUTCHMANS LANE SUITE 301
Provider Second Line Business Practice Location Address:
SUBURBAN MEDICAL PLAZA 3
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-2500
Provider Business Practice Location Address Fax Number:
502-896-2527
Provider Enumeration Date:
06/27/2008