Provider First Line Business Practice Location Address:
3022 TAYLORSVILLE ROAD
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:
502-454-3758
Provider Business Practice Location Address Fax Number:
502-454-4860
Provider Enumeration Date:
05/08/2007