Provider First Line Business Practice Location Address:
13113 EASTPOINT PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40223-4191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-244-5437
Provider Business Practice Location Address Fax Number:
502-244-5003
Provider Enumeration Date:
12/22/2006