Provider First Line Business Practice Location Address:
7984 NEW LAGRANGE 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:
40222-4718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-327-7706
Provider Business Practice Location Address Fax Number:
502-327-7417
Provider Enumeration Date:
06/01/2007