Provider First Line Business Practice Location Address:
3613 LEXINGTON 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:
40207-2949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-896-6171
Provider Business Practice Location Address Fax Number:
502-893-1839
Provider Enumeration Date:
10/31/2007