Provider First Line Business Practice Location Address:
2707 TUCKER 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:
40299-2952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-499-8208
Provider Business Practice Location Address Fax Number:
502-499-8209
Provider Enumeration Date:
10/24/2005