Provider First Line Business Practice Location Address:
3616 BUECHEL BYP
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:
40218-2270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-458-9511
Provider Business Practice Location Address Fax Number:
502-456-9285
Provider Enumeration Date:
07/10/2006