Provider First Line Business Practice Location Address:
8141 NEW LA GRANGE RD
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:
40222-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-7222
Provider Business Practice Location Address Fax Number:
502-423-7277
Provider Enumeration Date:
09/21/2010