Provider First Line Business Practice Location Address:
1904 EMBASSY SQUARE 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:
40299
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-581-0658
Provider Business Practice Location Address Fax Number:
502-581-9520
Provider Enumeration Date:
06/13/2006