Provider First Line Business Practice Location Address:
4919 DIXIE HWY
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40216-2554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-449-3400
Provider Business Practice Location Address Fax Number:
502-449-3838
Provider Enumeration Date:
10/13/2005