Provider First Line Business Practice Location Address:
4001 DUTCHMANS LN STE 6B
Provider Second Line Business Practice Location Address:
SUBURBAN MEDICAL PLAZA I
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-1891
Provider Business Practice Location Address Fax Number:
502-897-1893
Provider Enumeration Date:
05/27/2008