Provider First Line Business Practice Location Address:
919 AUDUBON PKWY
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:
40213-1301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-592-4479
Provider Business Practice Location Address Fax Number:
502-637-5538
Provider Enumeration Date:
09/25/2006