Provider First Line Business Practice Location Address:
5010 PRESTON HWY
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-966-5252
Provider Business Practice Location Address Fax Number:
502-968-3342
Provider Enumeration Date:
08/24/2006