Provider First Line Business Practice Location Address:
7980 NEW LA GRANGE RD STE 2
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:
40222-4767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-412-3636
Provider Business Practice Location Address Fax Number:
502-412-2827
Provider Enumeration Date:
06/05/2006