Provider First Line Business Practice Location Address:
1976 DOUGLASS BLVD
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:
40205-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-454-7627
Provider Business Practice Location Address Fax Number:
502-384-8203
Provider Enumeration Date:
10/26/2008