Provider First Line Business Practice Location Address:
2116 BUECHEL BANK RD
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:
40218-3521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-259-9101
Provider Business Practice Location Address Fax Number:
502-259-9109
Provider Enumeration Date:
09/29/2005