Provider First Line Business Practice Location Address:
6413 BARDSTOWN 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:
40291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-638-4906
Provider Business Practice Location Address Fax Number:
502-231-0220
Provider Enumeration Date:
11/05/2012