Provider First Line Business Practice Location Address:
3934 NORTH DIXIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-827-6207
Provider Business Practice Location Address Fax Number:
502-449-1931
Provider Enumeration Date:
07/30/2008