Provider First Line Business Practice Location Address:
3532 EPHRAIM MCDOWELL DR
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:
40205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-264-0521
Provider Business Practice Location Address Fax Number:
502-456-6655
Provider Enumeration Date:
09/25/2007