Provider First Line Business Practice Location Address:
6801 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-3913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-4500
Provider Business Practice Location Address Fax Number:
502-449-0108
Provider Enumeration Date:
05/26/2006