Provider First Line Business Practice Location Address:
7439 THIRD STREET 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:
40214-4366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-363-2473
Provider Business Practice Location Address Fax Number:
502-363-2473
Provider Enumeration Date:
03/06/2007