Provider First Line Business Practice Location Address:
8139 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:
40222-4682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-9509
Provider Business Practice Location Address Fax Number:
502-423-9501
Provider Enumeration Date:
12/06/2005