Provider First Line Business Practice Location Address:
4401-4505 LOUISE UNDERWOOD WAY
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:
40216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-363-6421
Provider Business Practice Location Address Fax Number:
502-363-2215
Provider Enumeration Date:
11/12/2006