Provider First Line Business Practice Location Address:
1430 POPLAR LEVEL 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:
40217-1345
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-636-0684
Provider Business Practice Location Address Fax Number:
502-636-8424
Provider Enumeration Date:
08/24/2006