Provider First Line Business Practice Location Address:
3834A TAYLORSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40220-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-451-9511
Provider Business Practice Location Address Fax Number:
502-451-7881
Provider Enumeration Date:
06/19/2006