Provider First Line Business Practice Location Address:
2137 DIXIE HWY
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:
40210-2242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-561-0490
Provider Business Practice Location Address Fax Number:
502-409-4964
Provider Enumeration Date:
05/21/2007