Provider First Line Business Practice Location Address:
2312 HIKES LANE
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:
40218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-479-7229
Provider Business Practice Location Address Fax Number:
502-479-0237
Provider Enumeration Date:
06/20/2006