Provider First Line Business Practice Location Address:
8521 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:
40242-3800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-644-5433
Provider Business Practice Location Address Fax Number:
502-814-3745
Provider Enumeration Date:
11/16/2007