Provider First Line Business Practice Location Address:
4036 1/2 DUTCHMANS LANE
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:
40207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-894-0322
Provider Business Practice Location Address Fax Number:
502-657-5046
Provider Enumeration Date:
08/11/2006