Provider First Line Business Practice Location Address:
4640 DIXIE HWY
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:
40216-2606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-447-3333
Provider Business Practice Location Address Fax Number:
502-447-3387
Provider Enumeration Date:
04/18/2013