Provider First Line Business Practice Location Address:
4546 TAYLORSVILLE 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:
40220-3528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-493-1040
Provider Business Practice Location Address Fax Number:
502-493-4754
Provider Enumeration Date:
05/02/2007