Provider First Line Business Practice Location Address:
6234C NORTH PRESTON HWY
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:
40229-4487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-955-6134
Provider Business Practice Location Address Fax Number:
502-955-6135
Provider Enumeration Date:
12/05/2005