Provider First Line Business Practice Location Address:
8800 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40258-1059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-935-7800
Provider Business Practice Location Address Fax Number:
502-935-7880
Provider Enumeration Date:
06/07/2006