Provider First Line Business Practice Location Address:
1101 HERR LN
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:
40222-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-210-5538
Provider Business Practice Location Address Fax Number:
502-327-5098
Provider Enumeration Date:
02/22/2007