Provider First Line Business Practice Location Address:
2240 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:
40205-2146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-479-9885
Provider Business Practice Location Address Fax Number:
502-479-9875
Provider Enumeration Date:
06/27/2005