Provider First Line Business Practice Location Address:
2001 LONG KNIFE CT
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:
40207-1176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-797-1371
Provider Business Practice Location Address Fax Number:
502-721-6132
Provider Enumeration Date:
04/02/2007