Provider First Line Business Practice Location Address:
3803 PRESTON HWY
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:
40213-1607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-366-7388
Provider Business Practice Location Address Fax Number:
502-366-3086
Provider Enumeration Date:
03/02/2007