Provider First Line Business Practice Location Address:
4602 SOUTHERN PKWY
Provider Second Line Business Practice Location Address:
SUITE 2E
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40214-1442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-361-1232
Provider Business Practice Location Address Fax Number:
502-361-1242
Provider Enumeration Date:
08/12/2005