Provider First Line Business Practice Location Address:
3019 PRESTON HWY
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:
40217-1716
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-637-2900
Provider Business Practice Location Address Fax Number:
502-637-2425
Provider Enumeration Date:
01/17/2007