Provider First Line Business Practice Location Address:
5538 NEW CUT 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:
40214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-380-1210
Provider Business Practice Location Address Fax Number:
502-380-1646
Provider Enumeration Date:
08/28/2006