Provider First Line Business Practice Location Address:
9302 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:
40242-3652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-594-9599
Provider Business Practice Location Address Fax Number:
502-326-3012
Provider Enumeration Date:
06/29/2006