Provider First Line Business Practice Location Address:
6506 WATCH HILL 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:
40228-1369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-239-3684
Provider Business Practice Location Address Fax Number:
502-231-7511
Provider Enumeration Date:
03/23/2007