Provider First Line Business Practice Location Address:
4615 DIXIE HWY STE A
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:
40216-3682
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-499-1189
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2008