Provider First Line Business Practice Location Address:
4000 BUECHEL BANK RD
Provider Second Line Business Practice Location Address:
AP4- 100B MEDICAL BUILDING
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-452-0777
Provider Business Practice Location Address Fax Number:
866-287-5090
Provider Enumeration Date:
08/30/2010