Provider First Line Business Practice Location Address:
2022 BROWNSBORO 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:
40206-2118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-897-3898
Provider Business Practice Location Address Fax Number:
502-895-7329
Provider Enumeration Date:
02/08/2007