Provider First Line Business Practice Location Address:
9325 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:
40242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-425-1521
Provider Business Practice Location Address Fax Number:
502-394-0148
Provider Enumeration Date:
01/19/2007