Provider First Line Business Practice Location Address:
2015 HERR LANE
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-426-0088
Provider Business Practice Location Address Fax Number:
502-426-7828
Provider Enumeration Date:
04/26/2007