Provider First Line Business Practice Location Address:
7321 NEW LA GRANGE RD
Provider Second Line Business Practice Location Address:
SUITE 112
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222-4800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-242-0640
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2016