Provider First Line Business Practice Location Address:
4229 BARDSTOWN RD
Provider Second Line Business Practice Location Address:
102
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40218-3241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-495-1888
Provider Business Practice Location Address Fax Number:
502-495-7515
Provider Enumeration Date:
03/22/2007