Provider First Line Business Practice Location Address:
2600 S POPE LICK 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:
40299-4708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-717-5959
Provider Business Practice Location Address Fax Number:
502-261-8212
Provider Enumeration Date:
04/15/2011