Provider First Line Business Practice Location Address:
6009 BROWNSBORO PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-1291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-253-6881
Provider Business Practice Location Address Fax Number:
502-253-6882
Provider Enumeration Date:
12/13/2006