Provider First Line Business Practice Location Address:
9500 TAYLORSVILLE 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:
40299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-491-1815
Provider Business Practice Location Address Fax Number:
502-671-8435
Provider Enumeration Date:
11/16/2006