Provider First Line Business Practice Location Address:
8117 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:
40222-4637
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-326-9950
Provider Business Practice Location Address Fax Number:
502-326-9952
Provider Enumeration Date:
09/11/2006